Posted and filed under Fraud, FWA, Healthcare.

Fraud Spotlight: Medicare Beneficiaries

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. Several weeks ago, I wrote a blog post about a case that I…

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Posted and filed under Fraud, FWA, Healthcare.

Fraud Spotlight: What About the “Other” Guys?

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. As some of you who follow healthcare fraud have likely read, the CEO…

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Posted and filed under Compliance, Fraud, Healthcare.

Fraud Spotlight: Fraud Fighters Love Data

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. Recently, there has been an unbelievable amount of bandwidth spent discussing telemedicine as…

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

3 Common Healthcare Fraud Schemes

Scroll through any law enforcement or OIG newsroom, and you’ll quickly learn that healthcare fraud comes in many shapes and sizes. There is no one-size-fits-all fraud scheme adopted by those looking to exploit the system for a buck (or a few million). This is what makes healthcare fraud such a persistent problem. Fraud examiners, enforcement…

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Posted and filed under Careers, Healthcare.

Where CFEs Can Find CPEs

Congratulations! You sat for your Certified Fraud Examiner (CFE) exam and passed! You’ve now got some shiny new letters after your name, and a LinkedIn profile to update. The only problem now – is keeping your credential! In order to maintain your CFE, you must complete 20 hours of Continuing Professional Education (CPE) credits every…

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

Fraud Spotlight: Self-Disclosure Protocol

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. I am surprised sometimes at the number of people in the healthcare field…

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

Examining The Fraud Triangle

Federal healthcare fraud recoveries totaled upwards of $2.3B in the 2018 fiscal year. This staggering sum is proof enough that healthcare fraud is here to stay as an unfortunate reality of the industry. Providers, patients, and insurers alike have all been complicit in various scams and schemes – which brings to mind the question: why…

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Posted and filed under Fraud, Healthcare.

Fraud Spotlight: Compounding Pharmacy Fraud

Recently, the State of New Jersey, Division of Consumer Affairs (the department that administers, among other things, the Prescription Monitoring Program [PMP]), reclassified a drug known as Gabapentin.  In reclassifying the drug, it is now considered a scheduled drug in New Jersey, and must now be part of the PMP reporting. For those that do not…

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Posted and filed under Community, Healthcare.

5 Ways to Have a Better Day

As a part of our YogAuditing initiative, Advize Health has brought on board two yoga instructors dedicated to the practice and its principles. Designed to enrich life and improve work performance, YogAuditing is a movement to inspire movement. Follow the journey with us by subscribing to our newsletter, reading our blogs, tuning in to our…

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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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