Impact in Action
Explore how Healthcare Fraud Shield helps organizations identify and prevent FWAE through real-world case studies. Our expertise supports clients in tackling complex challenges and achieving compliance across the healthcare payer market.
Client Success Snapshots
$1.8M
In Savings
Exposing False Records
Unusual Payment Spike: PostShield detected a $1.5 million payment increase over 15 months at a facility.
Employee Tip: A former employee reported that false medical records were being created to justify residential services.
Wider Investigation: Other connected facilities were also under scrutiny for similar practices.
Key Findings: Investigators uncovered fee-forgiving, misrepresentation of services, and billing for services not provided.
Action Taken: A flag was issued on the provider, leading to a $247.5K settlement.
$2.9M
In Savings
Billing Blunder
Service Misrepresentation: A provider was flagged for billing office visits when COVID-19 tests were actually conducted at home or drive-thru sites.
Wider Pattern: Further investigation uncovered other entities engaged in similar billing practices.
Medical Record Review: Documentation revealed cloned records, contradictions, and missing support for evaluation and management services.
Financial Impact: An $835K overpayment was identified, emphasizing the need for rigorous review and accountability in billing practices.
$920K
In Savings
Injection Irregularities
Risk & Payment Spike: PostShield flagged a provider for concerning trends in testosterone and B-12 injection billing for decreased libido and malaise.
Questionable Billing Practices: The provider heavily used modifier -25 with evaluation and management services.
Medical Record Review: Documentation failed to support the billed services.
Settlement Reached: After investigation, the provider settled for $360K, addressing discrepancies and preventing further losses.