Posts Tagged ‘healthcare’
AI in healthcare fraud detection is here! Protect yourself with Patient Options!
It is here folks! Machine learning and AI are going to be used in a proactive way to detect the fraud in the healthcare market. The investigators will be well down the trail of knowing who to audit before they even send the letter they will have a pretty strong idea of what they will…Read More
The most basic case of fraud.
Healthcare fraud happens all the time but the most classic case of fraud is charging for something and not performing the service. Let’s look at the at the recent arraignment of Primera healthcare executives in Atlanta Georgia. Tim Darnell from the ATL based paper patch writes in his article, “Primera Medical Group Execs Charged With…Read More
Serious Fraudulent billing in Texas. Don’t do this.
As a physician you have taken an oath to serve your patients to the best of your ability. In the environment of healthcare it is very easy to commit fraud, whether it be intentional or unintentional, it happens. One way to make sure that you land on the radar for an audit is to just…Read More
Healthcare rumblings with Stark law and how it can impact you.
Let’s delve into Stark law and how it impacts the delivery of healthcare. Stark Law is a set of United States federal laws that prohibit physician self-referral, specifically a referral by a physician of a Medicare or Medicaid patient to an entity providing designated health services (“DHS”) if the physician (or an immediate family member) has a financial relationship with that entity. This weeks article…Read More
Feds claim chiropractor brothers bilked patients out of $80M
$80 Million dollars out of one chiropractic practice. If that does not raise red flags. We are not sure what does. It certainly taints the chiropractic profession but can be found in other healthcare professions. This article comes to us via the New York Post by Kaja Whitehouse, “Feds claim chiropractor brothers bilked patients out…Read More
Keep an eye on your billing companies.
Keep an eye on your billing companies. If you use a billing company you will want to read this story coming out of Miami Florida. The Miami Herald originally ran this article, Their company did medical billing. Now, four of them are headed for federal prison by David J. Neal. This is a pretty sobering situation for…Read More
Most favored nations in healthcare
What is a most favored nations clause and why is it relevant to healthcare? Put simply it means that the insurer is getting the best price that the doctor is willing to give. How do many people violate this? Cash discounts. Lets look into the details straight from Evan Sznol’s Issue Brief: Most Favored Nation…Read More
Healthcare lab sued for $84 million in fraud case.
HDL labs is being accused of fraud to the tune of $84 million dollars by Cigna healthcare. Healthcare fraud comes with a hefty bill for any healthcare organisation but lets get some nice excerpts out of the article, “HDL sued for $84 million, accused of fraud” by Burl Rolett for RichmondBizSense.com. Cigna, a Connecticut-based insurer,…Read More
What makes healthcare so expensive?
Healthcare is expensive. I think we can all agree with that statement. Lets take a look at this excerpt from a Washington post letter to the editor, “The real villians in the health-care cost crisis” resonates with you as a doctor. Once again, doctors and hospitals are called the bad guys in the discussion regarding the…Read More