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”
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 …
It’s easy to see how healthcare fraud can cost taxpayers and governments billions of dollars every year. And while that is not something to be ignored, healthcare fraud also significantly impacts vulnerable populations like the elderly, those with severe illnesses and disabilities, and those on fixed incomes. When organizations take advantage of these individuals to …
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According to the National Library of Medicine, managed care refers to a healthcare insurance approach that integrates the financing of care and related services to keep the costs to the purchaser at a minimum while delivering what is appropriate for beneficiaries. The government has designed this delivery system to organize and manage healthcare between Medicaid …
Continue reading “Top Managed Care Fraud Trends to Look For in 2023”
Medical Loss Ratio (MLR) fraud occurs when plans knowingly misrepresent a proportion of funds spent on patient care and quality improvement measures as opposed to administrative expenses and profits. In this article, we take a deeper dive into MLR fraud and how it impacts our healthcare system. What is Medical Loss Ratio? The Affordable Care …
Continue reading “What Does Medical Loss Ratio Fraud Look Like in Managed Care”
Medicare Advantage is a type of health insurance plan offered by private companies contracted by the government. Also known as Medicare Part C, Medicare Advantage was designed to incentivize health insurers to develop innovative ways to improve care while decreasing costs. However, a report by the New York Times shows many of the large insurers …
Continue reading “Managed Care: Exposing Medicare Advantage Fraud and Abuse”
Illegal kickbacks in managed care insurance are costly schemes that corrupt the healthcare system. When dishonest managed care organizations (MCOs) devise unlawful kickback schemes to defraud government healthcare programs, physicians base their decisions on financial gain rather than the medical needs of their patients. It’s a dangerous crime that undermines the ethics of our medical …
Continue reading “Managed Care Insurance Fraud: Medicare and Medicaid Kickbacks”
Managed care insurance fraud is an unfortunate reality that affects taxpayers, the government, and the millions of individuals enrolled in government-funded health plans. It’s a costly crime that steals at least $308.6 billion from American consumers every year. We must all work together to put a stop to schemes like upcoding and phantom billing by …
Managed care is a form of health insurance that aims to reduce costs and improve quality of care by leveraging contracts with care providers and medical facilities to increase efficiency of coordinated patient care. Within the system, federal and state governments contract private insurers, also known as Managed Care Organizations (MCO), to provide health insurance …
Continue reading “The Impact of Risk Adjustment Fraud in Managed Care Insurance”
Fraud in managed care is an unfortunate reality that costs the government and taxpayers billions of dollars each year. Schemes like falsifying patient records, upcoding, cherrypicking, and enrollment fraud siphon money away from the 160 million Americans enrolled in legitimate government healthcare programs, increase taxes, and contribute to rising healthcare costs. This is why it’s …
