Counsel to a behavioral health provider network reached out to CRA’s Forensic Services Practice after potential areas of noncompliance surfaced during a routine internal review. Our team conducted forensic analysis that revealed inconsistently-applied billing modifiers across providers, settings, and services. While the claims had often passed internal checks, they generated a combination of underpayments and overpayments, causing regulatory exposure and creating reputational risk. The team quantified the exposure and recommended coding protocol refinements and targeted staff training to prevent future issues.
DOJ declinations show the value of early voluntary disclosure
US Department of Justice (DOJ) declinations involving Robert Bosch GmbH (Bosch) and Campus Eye Management Holdings LLC (Campus Eye) offer early insight into...