What are concurrent surgeries? Concurrent surgeries, also known as “double-booked” or “simultaneous” surgeries, occur when a surgeon is scheduled to perform more than one operation at the same time. In these cases, the surgeon might start one procedure, leave to begin or assist in another surgery, and then…
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What is the Universal Service Fund? The United Nations considers access to the internet to be a human right. The United States has taken steps to ensure that everyone, regardless of geography has access to the internet. It’s easy to provide broadband access in cities because of the…
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What is RUG score? A RUG (Resource Utilization Group) score in Medicare is used to determine the amount of reimbursement a facility receives for providing care to patients in skilled nursing facilities (SNFs). The score is calculated based on the level of care and resources required by the…
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What is upcoding? In the healthcare industry, billing codes are utilized to charge Medicare or Medicaid for patient services, with each code representing a specific procedure or diagnosis. These codes are used by the government to calculate reimbursement amounts. Upcoding happens when a healthcare provider submits a bill…
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Missed Opportunity: How a $50 Billion Medicare Fraud Shows the Need for Vigilant Whistleblowers Recent investigations have revealed a staggering $50 billion fraud perpetrated by insurers who exploited the Medicare Advantage program by inflating patient diagnoses. This fraud, which allowed insurers to collect payments for diseases that were…
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Cost plus percentage of cost contracts violate the False Claims Act. Let’s say you need to remodel your house. You interview a few contractors, decide on a plan, and then get to the really important part: how to pay for it. There are all sorts of ways to…
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Customer acquisition in healthcare. Finders fee, affiliate links, kickbacks. These terms all describe basically the same activity—customer acquisition—in different industries. Let’s take the example of affiliate links. Internet businesses are built on the backs of affiliate links. Sometimes a user knows exactly what they want and go to…
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Research fraud Traditionally, a researcher at an academic institution has been faced with two options: a) publish or b) perish. Successful publications bring money, attention, and sometimes fame to scholars and their sponsoring institutions. Others…perish? Not literally, but they probably don’t stay researchers for long. On top of…
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It is cheaper to make things in China. It is so cheap that it is cheaper to make things in China and then ship them to the United States. It is so cheap that a company can make things in China, ship them to Taiwan, disguise them as…
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As a general rule, patients want only the medical care that is necessary to get healthy. Provide the treatment that is necessary, so one can get back to living life. As a healthcare provider the incentives can be a little more mixed. Sure, there’s the Hippocratic Oath, but…
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