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....
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...
Thanksgiving is a time of bounty – for feasting, family, and giving thanks. It is a cornucopia of delicious food and cherished traditions. But for insurance companies, it can also be a stark reminder that while the holiday means time away from work, there are...
Healthcare Fraud Shield (HCFS) has officially launched RecordPlus™, a powerful new solution designed to transform how payers, auditors, and investigators review medical records. What It Does Medical records are one of the most time-consuming and error-prone components...
