now browsing by tag


The 7.39: Who is Sheridan Smith’s partner Jamie Horn? All you need to know | #tinder | #pof | romancescams | #scams

September 22, 2020 – 20:51 BSTFrancesca Shillcock The 7.39 and Becoming Mum star recently welcomed her first child with partner Jamie – meet her partner here… Sheridan Smith is back […] View full post on National Cyber Security

#bumble | #tinder | #pof Dow Futures, Exxon, Bumble, Zuora: 5 Things You Must Know | romancescams | #scams

Here are five things you must know for Wednesday, Sept. 2: 1. — Stock Futures Advance as Wall Street Sets More Records  Stock futures were rising solidly Wednesday after the […] View full post on National Cyber Security

Miley Cyrus: Fans Wants To Know If The Singer Is Dating Someone Or Not | #facebookdating | #tinder | #pof | romancescams | #scams

Trailers are an under-appreciated art form insofar that many times they’re seen as vehicles for showing footage, explaining films away, or showing their hand about what moviegoers can expect. Foreign, […] View full post on National Cyber Security

Are Kristen Stewart and Drew Barrymore SECRETLY DATING? Here’s what you need to know. | #facebookdating | #tinder | #pof | romancescams | #scams

Since Wonder Woman 1984 isn’t coming to theaters in October anymore, you’re gonna want to find some new stuff to watch at home. Thankfully, Disney+ and Hulu have a wave […] View full post on National Cyber Security

Shouldn’t your spouse let you know you’re in an open marriage? And more advice from Dear Prudence. | #facebookdating | #tinder | #pof | romancescams | #scams

“)), n = v(f[r.size_id].split(“x”).map(function (e) {return Number(e);}), 2), i.width = n[0], i.height = n[1]), i.rubiconTargeting = (Array.isArray(r.targeting) ? r.targeting : []).reduce(function (e, r) {return e[r.key] = r.values[0], e;}, {rpfl_elemid: s.adUnitCode}), […] View full post on National Cyber Security

We now know what Meghan Markle wore on her first date with Prince Harry | #tinder | #pof | romancescams | #scams

_________________________ What does one wear to meet a prince? It’s hard enough to figure out what you’ll wear on a Tinder date over Zoom so we don’t envy the dilemma […] View full post on National Cyber Security

#bumble | #tinder | #pof Know Someone Who Is Building The Next Instagram Or Spotify? Nominate Them — Or Yourself! – For The Next Forbes 30 Under 30 | romancescams | #scams

In the 10 years since we published the first Forbes 30 Under 30 list, the world has changed dramatically, but one thing has not: our history of spotting young innovators […] View full post on National Cyber Security

#cyberbullying | #cyberbully | Maharashtra Board SSC 10th Result 2020 to be Declared Tomorrow? Know Confirmed Date And Time | #parenting | #parenting | #kids

Maharashtra Board SSC 10th Result 2020: The Maharashtra State Board of Secondary and Higher Secondary Education (MSBSHSE) is expected to declare the SSC 10th Result 2020 on Monday. Though an official confirmation regarding the same is awaited, speculations are rife that the board will release the SSC 10th results on July 27 on the official […] View full post on National Cyber Security

THE ABC’S OF THE S.I.U.: What Providers Need To Know | Fox Rothschild LLP | #employeefraud | #recruitment | #corporatesecurity | #businesssecurity | #

Medical record requests by payors are commonplace for health care providers. Typically, these requests are received by a front desk employee who responds to the inquiry in short order.  Yet, not all requests should be treated the same.  When a request for documentation is propounded by the “Special Investigation Unit” (S.I.U.)  of an insurance company, special care should be exercised and provider involvement is required.

What is a S.I.U. anyway?  Over the past two decades, campaigns have intensified to curb fraud and abuse in health care.  On the government side, False Claims prosecutions have markedly increased and in the private sector, insurance companies have created specific departments to combat fraud.  The S.I.U. is a department within an insurance company with a targeted focus on recovering payments from medical providers that appear to be the product of fraud.  Individuals employed by a S.I.U. include former law enforcement personnel, claims adjusters and fraud analysts, among others, who receive specific training and credentialing in fraud detection.  These investigators utilize data analytics and other methods to flag providers for claims that fall outside of the “normal range” for the type of health care provider under review.

S.I.U. “audits” or requests for information about the practice should be taken seriously and taken to the top of your organization.   In many cases, special investigators receive incentives from the insurance company for recovering payments from providers.  They often attempt to “strong arm” a resolution by threatening a fraud claim, which in a number of states includes the prospect of treble (triple) damages, punitive damages, and attorneys’ fees.  In some cases, medical records produced by the provider (or the absence thereof) will assist the fraud allegation.  In others, the records will assist in supporting a defense to the same.

Here are 5 tips for your practice:

  1. Instruct  staff that all audit requests should be forwarded to the owner of the practice and the provider whose records are being requested.
  2. If the audit is deemed routine (not S.I.U. generated), instruct staff to make a copy of the records requested and the cover letter that attaches the records so that you can memorialize exactly what was provided and when.
  3. If you receive a letter from the S.I.U., reach out to an attorney who has experience in dealing with the S.I.U. to assist you through the process.
  4. If an investigator from the S.I.U. appears at your office, ask for a business card and do not let him/her disrupt patient care.  You can call them later (or your attorney can).
  5. Do not provide access to your electronic records or files to anyone — including anyone employed by a payor.

[View source.]

Source link

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

View full post on National Cyber Security