February 27, 2020

The New World of Auditing

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What’s next for auditing professionals? The first thing to note here is that I am not an auditor.  So, for me to write an article on auditing tips might seem a bit unusual. But this is not an article on auditing compliance, but rather on being an auditor – and…
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Providers are deploying their own AI to fight back against the tyranny of algorithms. In October of last year (2019), President Trump signed the “Executive Order on Protecting and Improving Medicare for Our Nation’s Seniors.” Section 9 of the Order entitled “Eliminating Waste, Fraud, and Abuse to Protect Beneficiaries and…
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CMS launches healthcare outcomes challenge. Expect more artificial intelligence (AI) in healthcare in 2020. We will see AI used primarily in diagnostics and auditing. In each of these areas, AI promises to impose drastic changes on society. As these changes reverberate through organizations, old work patterns will be disrupted. In…
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Google’s researchers apparently didn’t obtain HIPAA releases from patients. Recently, Google has made some stunning stumbles as it moves into the realm of handling healthcare data.  First, this is surprising, considering the growing distrust among the public and regulators of platforms like Google and Facebook. Second, and more surprisingly, it…
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EDITOR’S NOTE: This RACmonitor series examines a new type of auditing in healthcare – the use of algorithms. In the first article in this series, “Artificial Intelligence is Coming to Medicare Audits – Is Your Legal Team Obsolete?” Mr. Roche reported on statistical sampling being supplanted by more complex methods…
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AI presents an entirely new landscape for defense against audits. The Trump administration has launched a program to employ artificial intelligence (AI) in Medicare audits. Use of AI will make obsolete current legal strategies leveraged when defending providers. On Oct. 3, at a giant rally in Florida, the U.S. President…
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Hot topics come and go – and healthcare is no exception. A few years ago, predictive analytics (PA) was making its rounds, and I remember seeing several vendors at a few national healthcare conferences touting their use of this advanced statistical technique. In fact, at one conference, a backdrop used…
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Surgery has a long history. Even as long ago as in ancient Egypt, we have found remains showing evidence of trephination, the boring of a hole in the skull for brain surgery. More than a century of experimentation in repairing the intestines without causing sepsis eventually was solved with a…
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AI tools include anomaly detection, predictive analysis, and social network analysis. Medicare fraud is a serious issue and an expensive one. “Improper payments” amount to more than $52 billion per year. Our government uses subcontractors to do its work. They have corrected around $500 million (half a billion dollars) in…