Best Practices

Permanent or Past – What’s Your Evidence?

Evidence is vital in risk adjustment work, and not all evidence is the same, as we’ve blogged in the past. One area of growing concern is for conditions that may be permanent or which may improve and resolve. Let’s look at something like monoplegia or hemiplegia following a stroke. For some patients, weakness in part of the body responds to therapy and time, eventually resolving. Sadly, in some...

read more

American Senior Communities Settles for $5.5 Million in FCA Case

Thanks to the work of a whistleblower, the U.S. Department of Justice recently settled with an Indiana-based skilled nursing and long-term care services company for $5.5 million to resolve allegations that it violated the False Claims Act. A former American Senior Communities (ASC) employee filed a whistleblower lawsuit in 2017 alleging that that ASC was charging Medicare directly for various...

read more

500K American men get vasectomies every year – a specialist explains the easy and reversible procedure

This year, many vasectomy patients are young or single men concerned about unwanted pregnancy at a time when abortion care may not be as available as before. Thomas Barwick/Stone via Getty Images ~~~~~~~~~ About half a million men undergo a vasectomy in the United States in any given year. The percentage of men getting them had been dropping for the past two decades, but it looks like those...

read more

Inside the brains of aging dogs

In a citizen science project, thousands of pet dogs are helping scientists to understand what happens to memory and cognition in old age Hana aced her memory test. After viewing the contents of three identical boxes arrayed in an arc on the back deck of her home, the 3-year-old Cavalier King Charles spaniel had to remember which box held a treat — a task she quickly learned after just a few...

read more

Principal Care Management

Although chronic care management has been a CMS-covered care model for managing patients with multiple chronic conditions, this year, codes for a similar program were created. Principal care management (PCM) is a “sister” model – if you will – geared to patients with only one chronic medical condition. The goal of this program is two-fold: improving the patient’s quality of life & medical...

read more

Florida Man Gets 14 Years in Genetic Testing Fraud Scheme

The owner and operator of telemarketing and telemedicine companies faces 14 years behind bars after pleading guilty to healthcare and wire fraud and evading taxes. Through information filed Feb. 3, Marc Sporn of Delray Beach was accused of creating an elaborate scheme that cost Medicare more than $20 million dollars. According to court documents, Sporn owned and operated CPL Media Group Inc.,...

read more