Healthcare Fraud Shield’s Post

Healthcare Fraud Shield will be at the Healthcare Payment & Revenue Integrity Series in Boston September 13-14. Come say hi! You can also sit in on our session "The Intersection of Payment Integrity & Fraud, Waste and Abuse" with ♦Karen Weintraub, MA, AHFI, CPC-P, CPMA, CDC♦. #hcfs #fwa #paymentintegrity

Does your organization review the annual OIG-DOJ HFAC reports? Admittedly 139 pages is a lot to process. Pages 15-36 provide an informative snapshot of the most recent recoveries, settlements, and fraud trends in healthcare. More importantly, these reports highlight the return on investment (ROI) of hard-earned taxpayer dollars recovered from fraudsters and fraud schemes. For example, In FY2022 the ROI was nearly 3 to 1. #texasoversight #medicare #hcfac #hhsoig #medicarefraud #fraudtrends

Healthcare Fraud Shield started in 2011, but what does it say about a company when their executive team has been here since the beginning -12+ years and most of key department heads have been here 10+ years? It says: ✨we are doing something right as an company ✨you can trust our team to be here for you ✨you can feel confident that we aren't going anywhere and you won't have to wonder about turnover and continuity #hcfs #hcfraudshield #fwa #aiinhealthcare

Why do CMS and ACOs struggle to identify fraud in a timely manner? In the modern data science era it shouldn't be that difficult. Especially if you provide bounties (and corresponding protections) for #whistleblowers. I know they have RAC audits, which are accused of going too far at times; how is that program not picking up massive cases of #fraud such as the catheter scandal, or clinical lab scandals that keep coming up? (Or the opioid crisis that went on seemingly forever, a portion of which was funded by CMS.) #medicare

In 2023, the Department of Justice and the Federal government settled a record breaking $2.7 billion in False Claims Act cases, $1.8 billion related to healthcare cases - fraud and abuse. False Claims cases under Medicare are a large risk for providers today, especially given the perils of billing for substandard care, overbilling for care not deemed medically necessary or for care not substantiated by documentation to support the claim. More specifics on this issue, here: https://lnkd.in/gA3RNMHz

Re­duc­ing waste, fraud and abuse in Med­icaid is also crit­i­cal. As a first step, states should en­sure Med­icaid rolls are up to date while en­act­ing tem­po­rary lock­out pe­ri­ods for those com­mit­ting Med­icaid fraud in ad­di­tion to crim­i­nal charges. The na­tion­wide rate of im­proper pay­ments has reached 40% in some states ow­ing to fail­ure to ver­ify el­i­gi­bil­ity. This cost tax­pay­ers nearly $81 bil­lion in 2022.

When it comes to mitigating fraud, staying up to date on current scams might not be enough. For additional support, read these 11 strategies we recommend to help deter fraud attempts. #Fraud #HealthcareIndustry #FraudPrevention

In the latest edition of our False Claims Act Guide: 2023 and the road ahead, we analyze the key developments from 2023 and discuss how the most important cases and issues are shaping FCA enforcement now and in the year to come. #CTGT #clinicaltrials #digitalhealth #healthcare Virginia "Ginny" Gibson, Mike Theis, Greg Noonan, Jonathan Diesenhaus

When it comes to mitigating fraud, staying up to date on current scams might not be enough. For additional support, read these 11 strategies we recommend to help deter fraud attempts. #Fraud #HealthcareIndustry #FraudPrevention

Qui Tam in Healthcare Fraud In a realm as vast and intricate as the U.S. healthcare system, the latent specter of fraud haunts numerous transactions, dealings, and false claims. As enormous sums of money circulate through programs like Medicaid and Medicare, the temptation for malevolent actors to exploit the system burgeons. But there’s a vanguard in place, a system of checks and balances — #QuiTam under the #FalseClaimsAct (FCA). https://lnkd.in/eAV6mGtr