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

Fraud Spotlight: Understanding Medicare as a Secondary Payer (MSP)

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.  Recently, we discussed a situation where Medicare may still pay for a service, item or procedure…

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

Fraud Spotlight: Invest in Compliance – All Providers Are Audited

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. When determining if a practice should spend the time, effort, and expenses that are associated with…

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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 Compliance, Fraud, FWA, Healthcare.

Fraud Spotlight: How HRSA & The CARES Act Entice Fraudsters

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. One of the areas of reimbursement that has gotten very little discussion concerning…

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Posted and filed under Compliance, Fraud, FWA.

Profiting Off Of COVID-19? You Better Be Documenting.

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. Over the past couple of weeks, I have seen an unbelievable number of…

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

Fraud Spotlight: Compliance & The Reluctant Provider

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. Every compliance professional hopes that their employer buys into the suggestions, recommendations and…

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Posted and filed under Compliance, Fraud, FWA, Healthcare.
Posted and filed under Compliance, FWA, Medical Record Auditing, Payers.

Fraud Spotlight: Document Now, Ace an Audit Later

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. Every day, we read another article or another news release about the ever-changing…

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Posted and filed under Community, Compliance, Fraud.

5 Common COVID-19 Fraud Schemes

Relaxed Doesn’t Mean Right …and it certainly doesn’t imply safe. First, we are seeing it with Cybersecurity. Then, we will see more leniency with HIPAA and FWA around the practices and procedures that are occurring. We have seen unprecedented allowances in the past two months. CMS is relaxing the rules, telehealth is being set up to work…

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