When I was first hired as an OIG Agent, I was told by numerous people that fraud in the Medicare Advantage (MA) world was difficult to commit, and ever more difficult to prove. To put it into context, it was the mid-1990s, and MA plans were not where they are today. That being said, I always…
What is most important: identify, eliminate, recover or (PLOT TWIST) prevent? Coming off of a strong week of meetings with my clients and listening to their real pain points coupled with listening to hours of the podcast Do You Know This Man, and incessant Elizabeth Holmes reading and consumption, I sit on my 6am flight…
“Justice delayed is justice denied” by William Gladstone is a quote that comes to mind when I think about fraudulent providers and Elizabeth Holmes. I am obsessed with the podcast The Drop Out, featuring the trial of Elizabeth Holmes, and this week’s episode was released within days of the 600 pages of personal text messages…
The Justice Department has accused an upstate New York health insurance plan for seniors and its medical analytics company of cheating the government out of tens of millions of dollars. The civil complaint of fraud, filed late Monday, is the first by the federal government to target a data mining company for allegedly helping a…
“One-hundred percent of medical records have errors,” Heather Gantzer, MD, immediate past chair of the American College of Physicians’ Board of Regents, told MedPage Today. Well, that is a strong quote. Not sure we agree with all medical records having errors but we will say that we enjoyed the Open Notes Shines Light on Errors in…
This week our commentary on our favorite articles. We are excited to see that the issues we know are important are becoming more mainstream. A Florida chiropractor signed hundreds of mask exemption forms for students. Now, the district has tightened its mask policy (CNN) Without the political hyperbole, does a chiro signing off on mask…
The tagline from the CMS Website is “When Medicare Claims are submitted accurately, everyone benefits.” First – TPE why do we even care? Well, simple answer, it is a lovely little gift from CMS designed to help reduce claim denials and appeals through one-on-one help. As we can attest thorough masses of audits of provider…
A Florida orthopedic surgeon and designer of costly spinal surgery implants was arrested Tuesday and charged with paying millions of dollars in kickbacks and bribes to surgeons who agreed to use his company’s devices. Dr. Kingsley R. Chin, 57, of Fort Lauderdale, Florida, is the founder, chief executive officer and owner of SpineFrontier, a device…
COMMERCE CITY, Colo. — In her 19 years of living with cerebral palsy, scoliosis and other ailments, Cynthia Enriquez De Santiago has endured about 60 surgeries and her heart has flatlined at least four times. But the most unusual doctor’s referral of her life came last year: Go see an attorney. Enriquez De Santiago sought…
We talk to you every week about trials and cases that are in our rearview mirror. Often what we worked on directly. Sometimes we talk about areas of interest like healthcare cost and changing policy. Sometimes we bring you best practices based on our clients. Well, step aside normal headlines. This week the Berny Madoff…