Advancements in medical diagnosis and treatments often begin with clinical research and services performed at academic medical centers. Yet most compliance pros don’t realize...

Radiology services can be accompanied by some unique compliance challenges that do not always exist with other types of health care services. The following tips can help...

When conducting their periodic risk assessments, most compliance professionals use the OIG’s Work Plan or recent DOJ enforcement actions to help determine how best to deploy time...

Nowadays, rarely does a week go by without the Department of Justice announcing another settlement related to allegations of a lack of medical necessity resulting in false claims....

Recently, we posted about compliance risks associated with improper Evaluation and Management (E/M) Coding.

It’s finally here. The long-awaited, new OIG General Compliance Program Guidance (GCPG) has been released, all 91 pages of it. If you have not viewed it yet, click here: ...

When physicians or other clinicians submit claims for professional medical services, they select a medical code to represent the services. Procedures like a skin biopsy or an...

Two of the most significant healthcare compliance risks are medical coding and billing. Enforcement agencies like to “follow the money,” so to speak, and they often find it in...

Fraud, waste, and abuse (FWA) associated with telehealth services existed before COVID-19, but it significantly increased during the pandemic. An audit by the U.S. Health and...

Approximately 65 million Americans are enrolled in Medicare – about 34 million in traditional Medicare and the rest in Medicare Advantage. Traditional Medicare is administered by...