Document Fraud Overpayments 
Healthcare IT Today
FEBRUARY 17, 2023
This article focuses on the relatively young technologies that enable CMS to uncover overbillings, whether they be errors or fraud. Challenges of Investigating Overpayments Undeserved payments are needles lurking in the haystack of 135 million Americans enrolled in Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP).
Healthcare IT Today
MAY 5, 2023
The following is a guest article by Erin Rutzler, Vice President of Fraud, Waste, and Abuse at Cotiviti In Delaware, more than 250 Medicare patients underwent unnecessary genetic testing based on telehealth consultations that often lasted less than two minutes— costing Medicare thousands of dollars per patient. In 2021, a U.S.
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AIHC
APRIL 5, 2022
Only appeal claims when you have evidence and supporting documentation to substantiate your right to payment. Audit Coding, Billing and Documentation for Accuracy Insurance carriers and government contractors have the authority to review any claims at any time. However, it also includes documentation of a supporting diagnosis.
Compliancy Group
FEBRUARY 7, 2024
CMS UPIC audits are designed to identify and prevent fraud, waste, and abuse within Medicare and Medicaid, ensuring that federal funds are used appropriately and that the services billed for are actually provided and are medically necessary. Given their significant impact, healthcare organizations must take UPIC audits seriously.
Healthcare Law Blog
FEBRUARY 3, 2023
OMIG’s new Compliance Program Guidance outlines several best practices and provides examples of documentation that OMIG believes Medicaid required providers should maintain to demonstrate that the they have adopted, implemented and maintain effective compliance programs that meet each of the 7 elements specified in the regulations.
Health Care Law Brief
APRIL 12, 2023
405.986) or “reliable evidence” of fraud or “similar fault” (as defined in 42 C.F.R. Notable Omissions from Proposed Rule CMS declined to adopt previously proposed amendments to the standard for “identified overpayments” under Medicare Parts A, B, C, and D. 3729(b)(1)(A) of the False Claims Act (“FCA”). See Proposed Rule at 79559.
Med-Net Compliance
OCTOBER 21, 2022
The government’s primary civil tool for addressing healthcare fraud is the FCA. The risk categories are described as follows: Highest Risk—Exclusion: Parties that the OIG determines present the highest risk of fraud will be excluded from Federal healthcare programs to protect those programs and their beneficiaries.
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