In Audit
May 17th, 2018
There has been a lot of focus recently on large fraud schemes uncovered by the government and many are wondering how this affects “me.” By Evelyn Kim, MBA, CFE, CPC, CPMA, CRC, AAPC Fellow Healthcare fraud is a thriving enterprise in the United States. The latest statistics from the Centers for Medicare & Medicaid Services ...
In Audit
May 2nd, 2018
Have you always wanted to see what an Office of Inspector General (OIG) investigational take down of a healthcare fraud scheme is like? Now is your chance. The U.S. Department of Health and Human Services’ (HHS) has a “This is Real” series of podcasts, which takes you undercover with OIG special agents as they work ...
In Audit
Apr 30th, 2018
The April 2, 2018 issue of AARP Bulletin focuses on Medicare Fraud with a spread entitled “Medicare Under Assault” and the cover screaming that “crooks are stealing your healthcare dollars.” The article describes how medical coders and others are helping to identify and prosecute the scammers, who have figured out how to steal from Medicare by: Charging for services ...
In Audit
Apr 18th, 2018
Last June, U.S. Department of Health and Human Services (HHS) announced an ongoing effort to enhance transparency. One of its efforts has become updating the Office of Inspector General’s (OIG) Work Plan monthly, rather than annually. Another step HHS took to increase compliance transparency is by providing new tools and resources for the public to ...
In Audit
Mar 23rd, 2018
A medical review conducted by the Office of Inspector General (OIG) found 61 percent of claims (out of 300 sampled) for outpatient physical therapy services did not comply with Medicare medical necessity, coding, or documentation requirements. Although the Centers for Medicare & Medicaid Services (CMS) generally disagreed with OIG’s findings, a review of the requirements ...