Inside Look At Healthcare Fraud Prevention Algorithms

On July 30, 2011, the Centers for Medicare & Medicaid (CMS) implemented its new Fraud Prevention System (FPS), which uses predictive analytics technology, similar to that utilized by credit card companies, to move away from the “pay and chase” model to instead detect aberrant or fraudulent billing patterns prior to payment of claims. According to CMS, by fiscal year 2013, CMS was able to take administrative action against 938 providers and suppliers using FPS, saving or preventing $210.7 million in payments.

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Patient Records Required by NJ Medicaid

Documenting each patient encounter not only benefits the patient but it is also good preventative medicine for the doctor against claims of professional negligence, failure to meet certain professional standards, and investigations by government agencies. The position taken by most licensing boards and law enforcement agencies is that if an item or service is not documented in a patient’s medical record “it didn’t happen.” Below we discuss the minimum documentation requirements imposed by New Jersey Medicaid on participating providers.

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Smile, You Are On Candid Camera

While the doctor is busy treating patients, the patients may be busy documenting the doctor on camera. In this day and age when virtually every cell phone and tablet contains a video or photo camera, it is simpler than one might think.

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Advise Your Patients About Safe Disposal of Sharps

According to the Environmental Protection Agency (EPA), 9 million people in the U.S. use sharps — needles, syringes and lancets — at home. This equates to more than 3 billion disposable needles and syringes and 900 million lancets each year. Often times sharps used at home are discarded in the waste disposal or toilets. Such

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