Blog
Four Charged with Health Care Fraud and Related Crimes
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...
The OIG has released its 2025 Semiannual report to Congress with a focus on 5 areas of management challenges
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...
WHAT IS THE COST OF FRAUD?
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...
CMS Rolls Out Aggressive Strategy to Enhance and Accelerate Medicare Advantage Audits | CMS
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 its...
Some Best Practices for Those in Risk-Based Contracts
Recently we had a conversation that was centered around why some providers perform better in value-based contracts than others. In my opinion, there are three elements that ensure success: education, support and EMRs. 1. Education, education, education. There are...
View Our Recorded Webinar: Risk Adjustment, Revenue Integrity…Then What?
https://library.vbcexhibithall.com/recorded-webinar-risk-adjustment-revenue-integritythen-what/
MedPac projects that payments to Medicare Advantage in 2025 will be about 20% more traditional Medicare
In its most recent report to Congress, MedPac projects that payments to Medicare Advantage in 2025 will be about 20% more traditional Medicare. This report along with the recent confirmation hearing of Dr. Oz has brough renewed attention to the No Upcoding Act which...
“There is a new sheriff in town”
We can be assured that the increased scrutiny on Medicare Advantage will continue. During the first day of his confirmation hearings before Senate Finance Committee on Friday Dr. Oz called out the practice of over coding in Medicare Advantage to gain additional...
2025 RISE National Recap
I had the privilege of attending RISE National this week. As usual, it did not disappoint. Here is a summary: The landscape of Medicare Advantage has changed significantly and the need for increased oversight and strong compliance were discussed throughout the entire...
The growing trend towards value-based care leads to increased opportunities for Fraud, Waste, and Abuse.
The growing trend towards value-based care leads to increased opportunities for Fraud, Waste, and Abuse. Our healthcare landscape continues to rapidly shift from fee-for-service to value-based care (VBC). The Center for Medicare and Medicaid Innovation wants to...
Proud Sponsors of The 2025 Nationwide Children’s Hospital Championship
For more than 60 years, Nationwide and The Nationwide Foundation have proudly partnered with Nationwide Children’s Hospital to raise millions in support of its critical mission of providing care for every child, regardless of the family’s ability to pay. ...
Happy Holiday Season!
From Our CoventBridge Group Family to Yours!
View Our Recorded Webinar: A Payer’s Pathway to an Integrated Fraud, Waste, and Abuse Program
RECORDED WEBINAR: A Payer’s Pathway to an Integrated Fraud, Waste, and Abuse Program | VBCExhibitHall Library
Testing Laboratory Co-owner Sentenced for $3.8 Million in Fraudulent Billing
Testing Laboratory Co-owner Sentenced for $3.8 Million in Fraudulent Billing "ST. LOUIS – U.S. District Judge Sarah E. Pitlyk on Tuesday sentenced a former St. Louis County health care company owner to 20 months in prison and fined him $100,000 for submitting more...
Surveillance Snapshot! Quarter 3
Check out our Surveillance Snapshot! [video width="1080" height="1080"...
FIFEC Conference
The FIFEC - Florida Insurance Fraud Education Committee Annual Conference is just around the corner! Join Kimberly Talley, Megan Kutner, and many others from our CoventBridge Team in Orlando from June 26-28 #FIFEC2024 [video width="1080" height="1080"...
Chicago-area man charged in $60 million scheme that ordered COVID-19 test kits for dead people. (reshare)
Chicago-area man charged in $60 million scheme that ordered COVID-19 test kits for dead people. https://news.yahoo.com/news/chicago-area-man-charged-60-202200302.html
PRIDE Month
This month and every month, we want to honor & say thank you to our LGBTQ+ employees & community for everything you do to be equitable & spread respect throughout our organization. Happy #pridemonth to all! CoventBridge Group prides itself on fostering a...
RIMS Conference
THE 2024 RIMS (Risk and Insurance Management Society, Inc.) Conference is just around the corner! With more than 10,000 attendees and over 300 speakers, #RiskWorld is the largest risk and insurance event of the year. #RiskWorld #RiskWorld2024 #RIMS2024 #riskmanagement...
Surveillance Snapshot! Quarter 2
Check out our Surveillance Snapshot!
Afternoon Briefing: Man charged in scheme to bill $6.2M to Medicare in a month – Chicago Tribune (reshare)
Afternoon Briefing: Man charged in scheme to bill $6.2M to Medicare in a month – Chicago Tribune (reshare). https://www.chicagotribune.com/2024/05/31/afternoon-briefing-man-charged-in-scheme-to-bill-6-2m-to-medicare-in-a-month/
thINc360 conference
Today The Healthcare Innovation Company (thINc) will host the thINc360 conference where our very own, Raymond Evans, will present on the most efficient ways to identify, investigate and recover FWA. #thinc360 #FWA #PaymentIntegrity #fraud #fraudmanagement...
Eastern District of Kentucky | Lexington Doctor Sentenced for Kickback Conspiracy | United States Department of Justice (reshare)
Eastern District of Kentucky | Lexington Doctor Sentenced for Kickback Conspiracy | United States Department of Justice https://www.justice.gov/usao-edky/pr/lexington-doctor-sentenced-kickback-conspiracy
The RISE Risk Adjustment Forum
Join our VP of Healthcare Sales, Raymond Evans, today at The RISE Risk Adjustment Forum in New Orleans! Stop by our booth to catch up on all the trends in Fraud, Waste and Abuse solutions. #fwa #fraudwasteandabuse #riskadjustment #RISE [video width="1080"...
The Health Care Compliance Association (HCCA) Annual Compliance Institute
We’re less than a week away from The Health Care Compliance Association (HCCA) Annual Compliance Institute! Do you have the best partner to assist you in combating FWA? Connect with Raymond Evans, VP of Healthcare Sales, and Chandra Kuti, VP of Government Solutions...
Happy International Women’s Day!
Happy International Women’s Day! Today we celebrate the courage of women everywhere. #CoventBridgeCares #EmbraceEquity [video width="1080" height="1080"...
RISE National
We are less than a month away from #RISENational2024 in Nashville! Visit our CEO, Doug Merriman, our VP of Healthcare Sales, Raymond Evans, CFM, and our VP of Government Solutions, Chandra Kuti, PMP, MBA, SHRM-CP, to catch up on all the new trends in Fraud, Waste and...
IFM Conference
We’re less than a month away from The 2024 Insurance Fraud Management (IFM) Conference! Every year we look forward to the terrific education, industry updates, and quality time with customers! Connect with Kevin Lewis, CIFI, SCLA, Amy S. Hollis, Michael Scarlett Jr.,...
2024 HPRI South
Do you have the best partner to assist you in combating FWA? Join CoventBridge Group at the Healthcare Payment & Revenue Integrity Series Congress (HPRI) South 2024. Where Raymond Evans, VP of Healthcare Sales, and Chandra Kuti, VP of Government Solutions...
15th Annual Medicaid Innovations Forum
We are only a few weeks away from the 15th Annual Medicaid Innovations Forum in St. Petersburg Florida! Visit our, VP of Healthcare Sales, Raymond Evans, to catch up on all the new trends in Fraud, Waste and Abuse solutions. We look forward to seeing you Feb 5 &...
