Posted and filed under Coding, Fraud, FWA, Healthcare.

Fraud Spotlight: Another Ophthalmologist Fraud Bust

Retired OIG Special Agent and Advize’s Director of Litigation & FWA Support will be stepping in each week to examine current fraud trends from the lens of an investigator. Stay tuned for weekly insights, updates, and information on healthcare’s most expensive crimes. This past week, the US Attorney’s Office in the Southern District of NY…

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Posted and filed under Fraud, Healthcare.

Fraud Spotlight: The Unscrupulous Ophthalmologist

Over the last several weeks, I’ve been discussing some ways that unscrupulous providers take advantage of the system for their personal gain. But what about those underhanded providers who not only take advantage of the system itself, with things like services not rendered, medically unnecessary services, upcoding, and the slew of vernacular, but those same…

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Posted and filed under Compliance, Fraud, FWA.

Fraud Spotlight: COVID, Cross Fraud & FWA Detection

The Fraud Spotlight series is a long-form examination of current fraud trends and investigative strategies from our team of retired OIG agents and expert fraud investigators. Stay tuned for weekly insights, updates, and information on healthcare’s most expensive crimes. In the past few weeks, there have been some notable prosecutions concerning the on-going frauds associated…

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Posted and filed under Compliance, Fraud, FWA, Healthcare.

Fraud Spotlight: How Crises Can Impact Fraud Investigations

Retired OIG Special Agent and Advize’s Director of Litigation & FWA Support will be stepping in each week to examine current fraud trends from the lens of an investigator. Stay tuned for weekly insights, updates, and information on healthcare’s most expensive crimes. Hurricane Katrina and COVID-19, what do these two very different things have in…

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Posted and filed under Fraud, FWA, Healthcare.

Fraud Spotlight: The Curious Case of EOB/EOMB

Retired OIG Special Agent and Advize’s Director of Litigation & FWA Support will be stepping in each week to examine current fraud trends from the lens of an investigator. Stay tuned for weekly insights, updates, and information on healthcare’s most expensive crimes. Explanation of Benefits (EOB). Explanation of Medicare Benefits (EOMB). For those of you…

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Posted and filed under Coding, FWA, Payers.

Vision vs. Medical Coverage Making You Bleary-Eyed?

Billing issues, to an extent, are expected in any physician or healthcare provider office. Most patients are in possession of both medical and vision benefits coverage, and this duality often causes confusion in ophthalmology offices. Certain procedures that are performed in an ophthalmology office should be billed as medical procedures, and do not apply to…

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