FWA Briefs

Addressing and diving into the issue of hospice fraud in the United States, specifically with claims submitted for those who don't qualify for hospice or those who didn't receive hospice.

A recent fraud event involving a Chicagoland doctor will cost over $1 million and jail time from a mole removal scheme. The doctor submitted false claims for mole removals that were billed on multiple, separate dates of service, which allowed this doctor to receive larger reimbursements.

The Centers for Medicare & Medicaid Services (CMS) recently released new guidance that may affect certain providers wanting to obtain an NPI if they don’t already have one. These guidelines are important for you and your health plan to have protection against fraud, waste, or abuse (FWA) in your claims.

A Maine family practitioner used false claims billed to Medicare and Medicaid for services that were either not provided or not medically necessary, which provides reasons for the need of Fraud, Waste, and Abuse (FWA) protection.

A multi-million dollar scheme serves as a prime example to the benefits of Fraud, Waste, and Abuse (FWA) protection. The story of a doctor performing an alarmingly high amount of surgeries not typically conducted by their specialty is awakening to the need for robust safeguarding solutions.