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Weekly Updates on Healthcare FWA, Insurance, Law & other (typically) Healthcare related shenanigans™.
Your Best Weapon: Preparation & The Art of Interviewing
Data is great. Open-source information is helpful. Surveillance can provide insight. But nothing beats a good interview for getting to the heart...
The ACA Mandate: Why Providers Need a Compliance Plan
Providers, are you aware that the Affordable Care Act (ACA), often referred to as "Obamacare," mandates a compliance plan for those participating...
The New “Most Dangerous Game”: How Artificial Intelligence is Changing the Landscape of Healthcare Fraud
In the short story “The Most Dangerous Game” by Richard Connell (and the movies based on the story), a big game hunter traps humans on an island...
Just the Facts, Ma’am: Navigating Healthcare Investigations with Precision
The biggest mistake a healthcare investigator can make is to forget what their mission is. It is not to solve a crime; it is to follow the facts...
Fraud Hunters: Keep Your Eyes Open – Peculiar Business Pairings in South Florida
On a recent trip to South Florida, I came across some very interesting sights that gave me pause. The first was the combination of an Adult Day...
Back From NAMPI: Insights into the Fight Against Medicaid Fraud
Scottsdale was hot AF (Hot As Fraud) – temperatures were way over 105, and hot Medicaid Fraud topics were discussed. The National Association for...
Uncovering the Troubling Reality of Improper Payments in COVID-19 Programs: People with Insurance got COVID Services Paid by HRSA?!! You Don’t Say?
There is absolutely nothing in this report that should be interesting, shocking, or otherwise reflective of surprise. $784 million in improper...
Drugs: Deal or No Deal
The only government program that I can think of that did not authorize price negotiations for prescription medications was the Medicare Part D...
Fraud Hunters: Expanding the Scope
Every investigator knows that keeping your focus on the allegation is the key to efficiently conducting your investigation. There are times,...
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