Sep 30, 2025 | Forensic AI Alerts
Don’t be fooled by the “Two Midnight Rule” for single-day inpatient stays A single-day inpatient stay typically refers to an admission lasting one night, often for procedures or conditions such as childbirth, heart attack, stroke, bone fractures, or other acute...
Sep 3, 2025 | Forensic AI Alerts
Care Management Services are for the support and management activities delivered either directly by a physician or qualified healthcare professional (QHCP) under their supervision. These services are provided to patients living at home, in a domiciliary setting, a...
Aug 1, 2025 | Forensic AI Alerts
Early refills are an early warning signal to audit a pharmacy Codoxo uses Pharmaceutical Violations to identify pharmacies that may have improper billing. One of these violations is identifying claims that are potentially refilled too soon. Excessive violations...
Jun 27, 2025 | Forensic AI Alerts
Navigating Medication Therapy Management: Policies, Practices, and Identifying Potential Fraud, Waste, and Abuse Medication Therapy Management (“MTM”) has been shown to improve overall health and well being. MTM programs typically involve comprehensive medication...
May 29, 2025 | Forensic AI Alerts
Fighting Bad Behavior: Addressing Fraud, Waste, and Abuse in Applied Behavior Analysis As Applied Behavior Analysis (ABA) services for autism spectrum disorder continue to grow, so does the risk of fraud, waste, and abuse (FWA). With the implementation of the Mental...
Apr 30, 2025 | Forensic AI Alerts
Peeling Back the Layer of Skin Substitutes Background A skin substitute is a material used to replace or support damaged skin tissue. Skin substitutes may be allogeneic, xenogeneic, synthetic or a combination of these types of materials. When used appropriately,...
