Healthicity Blog

Medicare audit reports are often treated as retrospective summaries, documents that explain what went wrong after the fact. But for organizations focused on strengthening their audit programs, they offer something far more valuable: a forward-looking view of risk.

Preventing Medicare fraud and abuse requires risk-based planning, auditing, documentation, reporting, investigation, and corrective action tracking. Organizations must maintain consistent oversight, monitor trends, and document compliance activities to demonstrate accountability and reduce...

In this episode of Deeper Than the Headlines, we take a closer look at a case that initially sounds like a shocking headline, but reveals far more when examined through a compliance lens.

The Office of Inspector General (OIG) has released its long-awaited Industry Segment-Specific Compliance Program Guidance (ICPG) for Medicare Advantage (MA), offering a clearer picture of where regulators are focusing their attention and what organizations should be prepared to address.

Telehealth felt simple during the public health emergency (PHE). It wasn’t. We were operating under temporary flexibilities that masked how complex telehealth really is under Medicare statute. In our newest Compliance Conversations, CJ Wolf talks with Keisha Wilson, founder of KW Advanced...

The HHS OIG has added to their work plan an analysis of Medicare Advantage Enrollment. According to OIG, the Medicare Advantage program is vulnerable to schemes designed to increase Medicare Advantage organization (MAO) profits by improperly influencing enrollment. They explained that known...

Durable Medical Equipment

For decades compliance professionals have been reading Department of Justice press releases related to fraud, waste, and abuse involving durable medical equipment (DME). DME includes prosthetics, orthotics, and supplies (also known as DMEPOS).

An eye care organization in Pennsylvania recently agreed to pay $790,000 to resolve allegations of submitting improper Evaluation & Management (E&M) claims alongside bilateral eye injections. The violations, which occurred between 2018 and 2025, involved billing for same-day services in a way that...