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Benchmarks as the Signposts Along the Fraud Case Trail

Author: Kaldal, Karen

Source: Journal of AHIMA

Publication Date: November 1998

Traditionally, payers in the healthcare industry have relied on external tips or complaints for starting points for fraud investigations. But recently the number of leads on fraud activity has increased as the public becomes more aware of the issue. To combat this problem, payers have begun to....

Brailer to HIM: Continue 'Larger, Louder, and Faster'


Source: Journal of AHIMA

Publication Date: January 2007

“Do what you are doing larger, louder, and faster,” David Brailer, PhD, MD, told attendees during his general session presentation. Brailer, who served as national coordinator for health information technology in the Department of Health and Human Services from 2004 to 2006, thanked the audienc....

Coding Compliance: Practical Strategies for Success

Author: Prophet, Sue

Source: Journal of AHIMA

Publication Date: January 1998

"Fraud," "abuse," "upcoding," "unbundling," and "compliance" have all become buzzwords in the news media. Eliminating healthcare fraud and abuse has become a top priority for the federal government. Government investigations are on the rise and providers everywhere tremble at the thought of b....

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