Medical doctors should be able to focus on providing the best possible care for their patients. However, in the complex world of healthcare, it’s not uncommon for doctors to inadvertently become entangled in fraudulent schemes they are unaware of, such as medical billing or coding fraud. In this blog post, we’ll shed light on how …
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Will AI replace medical billing and coding and what impact would that have on billing fraud?
In the ever-evolving landscape of healthcare, advancements in technology continue to shape the industry. One area that has garnered attention is artificial intelligence (AI) and its impact on medical billing and coding, a critical component of healthcare administration. In this blog, we will explore the potential impact of advanced technologies and AI on medical billing …
National Whistleblower Appreciation Day: Recognizing the Courage and Challenges of Bringing Fraud to Light
In a world where accountability and transparency are paramount, whistleblowing serves as a powerful tool to combat fraud. Whistleblowers play a crucial role in exposing wrongdoing and protecting the interests of the public. As we delve into the significance of National Whistleblower Appreciation Day, we invite you to explore the importance of whistleblowing in the …
High-Profile Medical Billing Fraud Cases: A Case Study
Medical billing fraud continues to be a pervasive issue in the healthcare industry, causing significant financial losses and undermining the integrity of patient care. Healthcare professionals play a crucial role in ensuring accurate billing practices and upholding the ethical standards of the industry. In this blog, we delve into three high-profile medical billing fraud cases …
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Understanding Risk Adjustment Factor (RAF) Score Fraud and How to Get a Reward for Reporting It
Managed Care Medicare and Medicaid fraud have become pervasive in the United States, costing taxpayers billions of dollars annually. One form of healthcare fraud that has been on the rise is Risk Adjustment Factor (RAF) score fraud. RAF score fraud occurs when healthcare providers, managed care organizations, or insurers manipulate patient data to increase RAF …
The Benefits of Being the First to File a Whistleblower Claim in Exposing Healthcare Fraud
Whistleblowing to expose healthcare fraud is a courageous act that reveals unlawful practices and protects patients from substandard care. However, to be effective, whistleblowers must follow a specific set of rules in a timely manner, including being the first to file a whistleblower claim. In this article, we define what it means to be “first …
How to Report Nursing Home and Assisted Living Fraud
Medicare fraud within Assisted Living Facilities across the country. As more facilities take advantage of the system, it’s important to know how to spot the various forms of fraud that can occur in these settings. Identifying nursing home and assisted living fraud crucial in ensuring that beneficiaries receive the care they deserve and that taxpayer …
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Top 7 Most Common Medicare/Medicaid Scams by Medical Providers
Medicare is a federal health insurance program that covers eligible individuals who are over 65 years old, disabled, or have end-stage health complications. State or Federal insurance fraud is a type of healthcare fraud that occurs when healthcare providers, managed care organizations (MCOs) or nursing homes file false claims or use deceptive practices to receive …
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Billing and Upcoding: How Physicians Can Stand Up to Managed Care Organizations
As healthcare costs continue to rise, government programs such as Medicare and Medicaid, as well as private insurers, rely heavily on managed care organizations (MCOs) to manage patient care and keep costs under control. However, some MCOs engage in fraudulent practices such as medical billing fraud, which includes double billing and upcoding. These practices can …
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Typical Types of Fraud in Long Term Care Facilities and How to Report Them and Potentially Earn a Reward
Fraud within Long-Term Care and Assisted Living Facilities is a serious issue. It’s important to be aware of the various forms of fraud that can occur in these settings in order to protect residents, their families, and the taxpayers funding Medicare programs. Through education and awareness, you can help prevent long-term care fraud and ensure …