By Brian D. Murphy

In Part 1 of this series I introduced the developing story of UnitedHealth Group, Inc. vs. the United States of America, and my intent to write a series of articles on this civil fraud action. Why? Because I find this to be an incredibly interesting case with broad ramifications for CDI and coding departments.

The suit concerns a civil fraud auction brought by the United States of America, as represented by the DOJ, to recover damages and civil penalties under the FCA. Under the FCA, the government is entitled to recover three times the amount of damages which it sustained because of a defendant’s violation of the statute and, for each act by the defendant violating the statute, a civil penalty. A defendant violates the FCA when it “knowingly presents, or causes to be presented, a false or fraudulent claim for payment or approval.”

The key here is “knowingly.”

By Laurie L. Prescott, MSN, RN, CCDS, CDIP

Most likely you’ve already experienced peer reviews within your training; when you took your first record review and drafted your first queries, your manager or mentor looked over your shoulder and reviewed your work, offering you suggestions, guiding your efforts. Peer reviews work the same way, although they may be a bit more formal in function and execution.

Last week’s Talk10Tuesday podcast featured one of ACDIS’ own members, Tracy Boldt, RN, BSN, CCDS, CDIP, for a chat about outpatient CDI. Boldt is the system manager of CDI at Essentia Health, an integrated health system serving patients in Minnesota, Wisconsin, North Dakota, and Idaho, and helped to rollout their outpatient CDI program in July 2017.

Fall is one of the busiest times for ACDIS’ many local chapters. With school starting again, it seems the educational CDI events are keeping stride with those back-to-school schedules. In order to keep ACDIS’ event information up-to-date on the chapter pages and help get the word out, please remember to keep ACDIS in the loop as you plan your next great event.