by Blog Master | Jan 6, 2026 | MarketingBlog, Uncategorized
In case you missed it, the Office of Inspector General (OIG) has released Industry Segment-Specific Compliance Program Guidance. This comprehensive guide covers several key areas: • Access to Care• Marketing and Enrollment• Risk Adjustment• Quality of Care• Oversight...
by Blog Master | Jun 23, 2025 | MarketingBlog, Uncategorized
Here’s a case that hits on some longstanding areas of healthcare fraud, waste, and abuse (Durable Medical Equipment) and some newer ones (telehealth). This case also includes the anti-kickback law which is a federal law that prohibits individuals and organizations...
by Blog Master | Jun 3, 2025 | MarketingBlog, Uncategorized
The OIG has released its 2025 Semiannual report to Congress. In it they focus on the following 5 areas with management challenges: Public Health Financial Integrity Medicare and Medicaid Beneficiary Safety Data & Technology Security If you are a health plan who...
by Blog Master | May 28, 2025 | MarketingBlog, Uncategorized
What is the cost of fraud? This month a rheumatologist from Texas was accused of falsely diagnosing patients with chronic diseases to defraud the payers with false claims totaling $118 million he also administered unnecessary treatments that had potential harmful and...
by Blog Master | May 22, 2025 | MarketingBlog, Uncategorized
CMS Rolls Out Aggressive Strategy to Enhance and Accelerate Medicare Advantage Audits | CMS “We are committed to crushing fraud, waste and abuse across all federal healthcare programs.” – Dr. Mehmet Oz, CMS Administrator. CMS just announced a huge expansion of...
