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 from offering or receiving anything of value in business transaction reimbursable by a federal healthcare […]

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 wants to bolster your fraud, waste and abuse efforts CoventBridge is here to […]

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 even fatal side effects. He was sentenced to 10 years in prison with 3 […]

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 auditing efforts for Medicare Advantage Plans.  Is your plan ready? CoventBridge can help.  […]

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 countless different value-based arrangements. Our industry is in the midst of a monumental change from fee […]

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 was introduced by Senator Bill Cassidy (R-LA) which calls into question […]

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 revenue as fraud.   – Colleen Gianatasio, VP of Compliance (CoventBridge Group) Quote From […]

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 accelerate healthcare reform through VBC models with a stated goal of all Medicare beneficiaries with Parts A and […]

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.  https://ncc-golf.com/tournament-info/overview/  

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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

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

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 diverse & inclusive culture. #Pride #LGBTQ #CoventBridgeCares

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 #investigations #claims #claimsfraud #fraud #insurance #insurancefraud #surveillance #investigators #insuranceinvestigations #workerscompensation #workerscomp #fraudabatement #fraudwasteandabuse

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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/    

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 #investigations #investigators #fraudabatement #surveillance

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  

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

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 Operations, to discuss the many opportunities we have to identify, investigate and […]

Happy International Women’s Day! Today we celebrate the courage of women everywhere. #CoventBridgeCares #EmbraceEquity

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 Abuse solutions. Thank you, RISE, for all your handwork in planning […]

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., and Doug Merriman. #IFM2024 #fraud #fraudmanagement #claims #claimsfraud #insurance #insurancefraud #investigations #investigators #insuranceinvestigations #workerscompensation #fraudabatement #workerscomp #workerscompensationclaims #surveillance

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 Operations, will discuss with you the steps being taken to fight healthcare fraud during our session FWA: Leveraging the BIG […]

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 & 6! #FWA #investigations, #fraudwasteandabuse

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Visit CoventBridge Group‘s Healthcare Fraud Solutions team at the 7th Annual Medicare Advantage Leadership Innovations Conference, scheduled for January 30-31, 2024, in Scottsdale, Arizona. Discuss all the new trends in Fraud, Waste and Abuse solutions with Raymond Evans, our VP of Healthcare Sales, and Chandra Kuti, our VP of Government Solutions Operations. We can’t wait to see you in Scottsdale! […]

On #MLKDay2024 let’s not only celebrate his legacy, but continue pursuing our learnings in honor of it. “The time is always right to do what is right” – Martin Luther King