Over the past few weeks, we have been engaging with clients on a variety of topics, the most recent being the discussion of “code rotation.” Some have asked what we mean when we discuss this term of art. We had often heard this term used by our retired OIG agents and thought it was an…
Should a patient who suffers a medical condition as a result of their treatment have to pay for the resulting treatment? Should the financial responsibility go to their insurance or the facility that caused the problem? Before everyone starts hitting the comment button and mentioning hospital-acquired conditions, let us set the stage for the scenario:…
Even more than money … what about the standard of care? This week’s Fraud Spotlight features guest contributor Mark R. Brengelman, JD, MA. Be sure to tune into the column for more expert insights from our network of providers, investigators, and fraud experts. This article points out another violation of law related to dental misconduct in addition…
This week’s Fraud Spotlight features guest contributor Mark R. Brengelman, JD, MA. Be sure to tune into the column for more expert insights from our network of providers, investigators, and fraud experts. …What do the records say? This article points out additional violations of law related to fraudulent dental misconduct – medical records forgery or simple lack…
Over the past few weeks, we have been blogging and posting about the “red-headed step-child” of healthcare fraud, dental fraud. One of our retired OIG agents recently heard this tale, which bears repeating: At a recent visit, his mother was told by the treating dentist that she had a gum infection and needed to see…
This week’s Fraud Spotlight features guest contributor Mark R. Brengelman, JD, MA. Be sure to tune into the column next week for more examples of dental fraud from real cases! This article points out some basics of dental misconduct – fraud. A dentist who bills for services not performed is committing fraud. For example, billing for the…
This week’s Fraud Spotlight features guest contributor Mark R. Brengelman, JD, MA. Be sure to tune into the column next week for more examples of dental fraud from real cases! This article points out a unique aspect about dental fraud that has significant impacts on the dental office and the dentist who practices there –…
Our Founder and Managing Director Jeanmarie Loria sat down with retired OIG Special Agent Eric Rubenstein to discuss dental fraud, unscrupulous dentists, and the claims-related intricacies of the dental industry. Here’s how it went… JL: My aunt in California paid an additional $10 for personal protective equipment (PPE) on top of her dental visit. Other members…
Next Week On The Blog: Jeanmarie Loria sits down with her partner Eric Rubenstein, retired OIG Agent, to ask him why he had more cases on pharmacy pain management and DME than dental fraud. Dental fraud stinks worse than the most severe case of halitosis. Picture this. Brooklyn NY 1960. All 5 of…
Friend of Advize and healthcare payer expert Dino Kasdagly put together a helpful resource for healthcare professionals looking to quickly refresh their knowledge on Medicare as a Secondary Payer practices. Below you will find several popular instances in which Medicare benefits are secondary to Group Health Plan (GHP) benefits. If the documented employer has more…