Recent actions by the Centers for Medicare & Medicaid Services (CMS), including targeted spending reviews and the Comprehensive Regulations to Uncover Suspicious Healthcare initiative, known as CRUSH, reflect a measurable shift in federal oversight expectations....
The American Dental Association (ADA) introduced significant updates to the Current Dental Terminology (CDT) code set in 2026. These changes reflect an industry shift toward advanced technology and a more nuanced approach to patient care. However, if these new codes...
Fraud is evolving faster than traditional controls. Schemes are more coordinated and documentation is more engineered. Billing patterns are designed to survive first-pass reviews. And many organizations are still reacting after payment. If you lead SIU, compliance,...
Applied Behavior Analysis (ABA) is commonly used to treat individuals with Autism Spectrum Disorder (ASD). Treatment is designed to improve communication, social skills, and adaptive learning. However, as the prevalence of ASD diagnoses has risen, so has the risk for...
Hospice is designed to provide comfort and supportive care to terminally ill patients with a prognosis of six months or less. However, the high per diem payment structure makes it a significant target for sophisticated fraud schemes. Improper billing for hospice...
“Listen, Linda!” We’ve all seen, laughed at and maybe even quoted the viral video of the little boy trying to debate his side of a disagreement with his mother. And while that clip is a source of Internet amusement, the need to listen, or rather, the...
