Significant Upcoding Risks Emerge with Medicare Advantage

significant upcoding risks emerge with medicare advantage

Christi Grimm, the Inspector General of HHS, gave a recent keynote address to compliance professionals. In it, she said, “Simply put, the financial incentives created by risk adjustment may be driving upcoding in the severity of diagnoses to garner additional payments.”

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Telehealth Enforcement Actions

telehealth enforcement cj wolf

“It behooves all healthcare compliance professionals to be aware of the fraud, waste and abuse risks associated with telehealth services. This mode of delivery holds great promise. For it to fulfill that promise, non-compliance needs to be rooted out and corrected.”

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Integrating Compliance into Human Resources Processes   

compliance and human resources HR, lisa herota

“The secret to my success in reinforcing the value of Compliance’s work comes from partnering with HR. Developing standard interview questions, building leadership competencies, and sticking your neck out to establish strong relationships across the organization are crucial to demonstrating how Compliance delivers value.” – Lisa Herota

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