Medical billing fraud is a rampant problem that affects all areas of the healthcare industry. Unfortunately, rehabilitation (rehab) therapy fraud is on the rise, posing significant challenges for the healthcare system, taxpayers, and patients alike. In this article, we will delve into the world of rehab therapy fraud, identifying red flags that rehabilitation therapists and …
Continue reading “How to Spot the Red Flags of Physical, Occupational and Speech Therapy Fraud”
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 …
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 …
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 …
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 …
Continue reading “High-Profile Medical Billing Fraud Cases: A Case Study”
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 …
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 …
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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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 …
Continue reading “Top 7 Most Common Medicare/Medicaid Scams by Medical Providers”
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 …
Continue reading “Billing and Upcoding: How Physicians Can Stand Up to Managed Care Organizations”
