BlickenWolf - News & Events - Published Articles

Published Articles and White Papers by BlickenWolf

BlickenWolf consultants are sought after writers and speakers on topics related to healthcare integrity and provide a steady stream of valuable information to local and national healthcare compliance publications. Additionally, several white papers on the healthcare industry, written by BlickenWolf consultants, are available for review online. The topics cover an in-depth review of Medicare Managed Care and Corporate Integrity Agreements.

Published Articles

May/June 2007 - BlickenWolf LLC Tracks Industry Trends to Help Clients Meet Higher Demands for Compliance and Improvement of the Bottom Line (.pdf), as appeared in News & Profiles newsletter, Healthcare Financial Management Association - Wisconsin Chapter

March/April 2007 – The Case of DRG 243: A Practical Approach to Utilizing PEPPER Reports (.pdf), as appeared in First Illinois Speaks newsletter, Healthcare Financial Management Association - First Illinois Chapter

May 2006 – Spice up your compliance program with PEPPER – Being proactive in reducing payment errors may prevent healthcare law enforcement from targeting you (.pdf), as appeared in Compliance Today

January 9, 2006 – Top Fraud and Abuse Enforcement Predictions (.pdf), as appeared in Medicare Compliance Alert

October 3, 2005 – CMS Expands the Post Acute-care Transfer Policy (.pdf), as appeared in Medicare Compliance Alert

April 11, 2005 - Hospital's Nightmare Ends as Judge Rejects Fraud Allegations Related to Nurse Ration (.pdf), by Carmen Wolf, as appeared in Report on Medicare Compliance, published by Atlantic Information Services, Inc.

December 10, 2004 - Chapter clarifies culpability in corporate fraud by Carmen Wolf appears in guest column of The Business Journal Serving Greater Milwaukee

October 2004 - Ken Blickenstaff bylined the article, "Healthcare and the Upcoming Amendments to Federal Sentencing Guidelines: Impact on Compliance Programs" for Fraud Magazine

September 2004 - Carmen Wolf bylined the article, "Implications and Practical Applications of Federal Sentencing Guideline Changes on Healthcare Compliance Programs", Compliance Today

September 2004 - Ken Blickenstaff bylined the article, "Upcoming Amendments to Federal Sentencing Guidelines: Impact on Compliance Programs" for Fraud Magazine

September 2004 - Carmen Wolf bylined the article, "Upcoming Amendments to Federal Sentencing Guidelines: Impact on Compliance Programs" for News & Profiles

August 16, 2004 - In Big Gamble, Health System Abandons Compliance Amid Bad News; IRO Quits: Report on Medicare Compliance (.pdf), as appeared in Report on Medicare Compliance, published by Atlantic Information Services, Inc.

Serial Billers and Underutilizers: New Trends in Healthcare Fraud and Compliance, published in Corporate Counsel Magazine and Checklist to Compliance

U.S. sets its sights on “serial billers” to fight Medicare fraud, Chicago Daily Law Bulletin

The Evolution of Healthcare Fraud Enforcement: A Power Prescription, National Law Journal

The Realities of Living Under a Corporate Integrity Agreement, The Journal of Health Care Compliance

Integrity Agreements: A Tricky Affair, Healthcare Business

Recent Trends and Developments in Health Care Fraud, Health Care Fraud Report

The Indiana Medicaid Fraud Control Unit: Its Role in the Fight Against Medicaid Fraud

Published Papers

The Challenges Posed by Medicare Managed Care (.pdf), as written by former BlickenWolf manager in 2004

Abstract

This paper analyzes the challenges posed by Medicare Managed Care. Healthcare reimbursement in the United States has a long and complex history. Perhaps the most influential piece of healthcare legislation passed to date is Public Law 89-97, which brought Medicare into existence in 1965. The initial purpose of this bill was to provide public insurance for the medical care of the aged and the disabled. As healthcare costs in the United States rose dramatically in the 1970's and 1980's, the federal government began investigating more cost-effective health care delivery systems. One form of cost containment is managed care. Although managed care companies offer a range of supplemental benefits to cover the substantial out of pocket costs not covered by Medicare, it also presents several challenges.

Corporate Integrity Agreements: Do They Change Organizational Culture? (.pdf), as written by former BlickenWolf manager in 2005

Abstract

This paper seeks to evaluate whether or not a providers/entities organizational culture changes because of the existence of a CIA. As the number of laws increase to combat health care fraud, so do the number of providers/entities that violate them. Once a provider/entity has been accused of health care fraud one of four actions can be taken by the federal government to punish them, included are: 1) jail sentences, 2) fines, 3) exclusion from federal government programs, or 4) the establishment of a Corporate Integrity Agreement (CIA). Most common is the CIA. The CIA is a mechanism that prevents providers/entities from being excluded from a federal government program by instituting a written agreement between the provider/entity and the Office of Inspector General (OIG). This written agreement, which can typically last from 3-9 years, requires the provider/entity to comply with the standards set forth in the CIA by establishing or revising a proactive compliance program, which seeks to ensure fraudulent acts will not reoccur.

Billing Fraud: Does it Have a Financial Impact on the Healthcare System? (.pdf), as written by former BlickenWolf manager in 2005

Abstract

Of the numerous significant issues facing healthcare today, there is one in particular that will continue to have an effect in the next decade, which is healthcare billing fraud. Healthcare billing fraud is a particularly vital issue as the effect on the healthcare system can be enduring and ongoing. Fraud, as defined by the Centers for Medicare and Medicaid Services (CMS), is an intentional deception or misrepresentation that someone makes, knowing it is false, that could result in the payment of unauthorized benefits (CMS, 2005). The purpose of this paper is to evaluate the significant financial impacts that billing fraud has on the healthcare system. This paper will begin by presenting the history of healthcare billing fraud, types of billing fraud, followed by an overview and evaluation of the impact billing fraud has on the healthcare system by looking at the following cohorts: consumers, healthcare entities, healthcare providers, insurance companies and lastly, the federal government.