Posted and filed under Dental, Fraud, FWA, Medical Record Auditing.

Dental Fraud: Standard of Care Violations

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…

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Posted and filed under Dental, Fraud, FWA, Medical Record Auditing.

A Frank Discussion on Dental Fraud

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…

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

Fraud Spotlight: Provider Negligence & Ignorance are Non-Compliance

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.  For the past few weeks, we have been standing on the soapbox and waving the flag…

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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 Coding, Compliance, Fraud, FWA, Medical Record Auditing.

Fraud Spotlight: Understanding the 3 Types of BLS Transport

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. Previously, I wrote a couple of blogs about the continued fraud in the…

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

The 3 Ws of USDHHS OIG OI

Peggy Glynn, a former OIG Field Agent returns in this week’s guest blog post. Her friendship, insights, and experiences in the OIG are incredible tools for those looking to learn more about fighting healthcare fraud, waste, and abuse. What is the USDHHS? Who is the OIG? Why do you care about the OI? What: USDHHS…

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

Fraud Spotlight: Types of Healthcare Fraud Cases

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 Last week, I discussed the three main types of subpoenas that are typically…

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

Fraud Spotlight: The Kyphoplasty & The Qui Tam

This week’s Fraud Spotlight article was written by Peggy Glynn, a former OIG Field Agent from Buffalo, NY. Her friendship, insights, and experiences in the OIG are incredible tools for those looking to learn more about fighting healthcare fraud, waste, and abuse. Who is Kyphon Inc., what is a kyphoplasty, and where does the Civil…

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

Fraud Spotlight: Economic Healthcare Fraud Perspectives

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.  This past week, while having lunch with a friend who knew about my…

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Posted and filed under Fraud, Medical Record Auditing.

Behavioral Health Billing Errors

A 2017 audit fronted by Massachusetts State Senator Suzanne M. Bump revealed over $190 billion dollars in improper or ambiguous payments within MassHealth’s Behavioral Health program. The audit uncovered years of questionable billing practices, lack of administrative oversight, and conflicting understandings of requirements, regulations, and internal policies. The Senator went on the record explaining the…

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