latest content

featured content

filter by categories

can healthcare fraud special investigators keep up the pace?

This week the U.S. Justice Department announced one of the biggest multi-agency healthcare fraud busts in history involv...

when waste becomes fraud: where do you draw the line?

Under HIPAA, healthcare fraud is defined as “knowingly, and willfully executing or attempting to execute a scheme … to d...

busted: the top fraud and abuse busts in Q1 2017

Tens of billions of dollars are wasted each year thanks to fraudulent healthcare billing practices, according to the Nat...

busting myths about clinical claim review

We know that automated claim editing is unable to analyze many claims due to their clinical complexity, the most obvious...

how far can automated claim editing go? three fast facts you should know

There’s no question that automated claim editing is a crucial component of accurate and efficient claims payment. Using ...

the true costs of medical identity theft

$13,500. That is the average cost victims pay to resolve medical identity theft—when they can resolve it.   Medical iden...

are your improper payments hiding in plain sight?

After years of focusing efforts on speeding up automated claim processing, most payers’ claim review systems have uninte...

common FWA overpayments your automated claim editing system may miss

The cost of healthcare continues to dominate headlines as the Affordable Care Act (ACA) expands managed care, and thus p...

why "no assembly required" is a welcome phrase for fraud investigators and parents alike

If you’ve ever purchased a bunk bed, swing set, or bicycle for your child, you likely recall the hours it took to progre...

busted 2016: prominent healthcare fraud schemes

The National Health Care Anti-Fraud Association (NHCAA) estimates that tens of billions of dollars are lost each year to...

don’t miss an update

leave a comment below: