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In a 2019, one of the largest Health Care Fraud schemes ever charged, federal investigations and prosecutions resulted in charges…

In a recent healthcare fraud case, from a short timeframe of November 2022 through May 2024, over $1.2 billion dollars…

by Steve Nesnidal, MD, CPC, AHFI Medical coding provides several important functions in healthcare. One of the main functions is…

by Steve Nesnidal, MD, CPC, AHFI A non-physician assistant at surgery–physician’s assistant (PA), nurse practitioner (NP), or clinical nurse specialist…

by Steve Nesnidal, MD, CPC, AHFI Fraud, Waste and Abuse (FWA) in Hospice is a significant US Healthcare problem. CMS…

by John Danza As a leader in the Medicare reference-based pricing (RBP) space, Context is frequently asked two questions: Our…

by Steve Nesnidal, MD, CPC, AHFI Dr. Steve Nesnidal of Context4 Healthcare, Inc. presented at the 2023 NHCAA Annual Training…

by Steve Nesnidal, MD, CPC, AHFI A common Fraud, Waste and Abuse (FWA) pattern detection involves monitoring for and analyzing…

by Steve Nesnidal, MD, CPC, AHFI A suburban Chicago doctor will spend 6 months in jail and pay a $1…

by John Danza CMS recently released a guidance letter concerning if HIPAA rules would prohibit a health plan from requiring…

A pain management practice will pay $625k from a False Claims Act violation. Similar cases give an importance to Fraud, Waste, and Abuse (FWA) protection, and the use of E/M codes would have detected an abnormality on similar claims. Read more to find out how.

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.