Tag Archives: coding compliance

WWR – Kaiser agrees to pay $6.4 million to settle claims it received inflated Medicare Advantage payments

Kaiser joins the undignified ranks of the companies investigated for committing fraud.  This timely article from Healthcare Finance News doesn’t use that word, but it describes the finding that Kaiser “knowingly submitted” false diagnoses to inflate its payments, which is … Read Full Post

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Lessons from the Cigna/DOJ Lawsuit: Health Risk Appraisals (Part 2)

Last week’s first installment of this blog started our review of HRAs in the MRA environment.  Let’s continue searching for lessons to apply in your practice. A third issue with Cigna’s HRAs was the supposed expectation to capture all the … Read Full Post

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Compliance Tool-kit Should Include External Validation

Although all providers should have a Compliance Program, it seems that mostly larger groups have them in place and even then, to varying degrees.  Many practices have some form of internal validation of a coder’s work; most of the time, … Read Full Post

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Lessons from the Cigna/DOJ Lawsuit: Health Risk Appraisals (Part 1)

This blog is the first in a series of lessons, or reminders, gleaned from the Department of Justice’s (DOJ) lawsuit against health insurer Cigna. The suit alleges that Cigna essentially committed fraud by reporting false information to CMS in a … Read Full Post

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What We’re Reading – DOJ Launches Lawsuit Against Anthem for Risk Adjustment Fraud

As detailed in this article, Anthem is facing a lawsuit initiated by the Department of Justice (DOJ) for allegedly failing to remove erroneously submitted diagnoses from CMS’s database despite knowing that inconsistencies might be present. The health insurance carrier commissioned … Read Full Post

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