Actual Loss is defined as “reasonably foreseeable pecuniary harm that resulted from the offense.” Intended Loss is defined as “the pecuniary harm that the defendant purposefully sought to inflict.” For us that do not have a law degree, what does this all mean? In the federal criminal system, a defendant’s potential prison exposure is based…
We provide a lot of advisory and consulting services for the legal community. Our Former HHS-OIG Special Agents have that very niche experience in the ability to speak healthcare fraud, waste and abuse as well as legalese. In working with the various law firms on criminal, civil and administrative matters, it becomes clear that having…
Recently, Advize Health was involved in a matter pertaining to some medical record audits and investigations that were ongoing with a Social Adult Day Care (SADC), located on the West Coast. For a five year period, this SADC was the subject of audits, investigations and referrals made by the state Medicaid agency to the Medicaid…
In 2012, the National Council on Prescription Drug Programs (NCPDP) made a change to the manner in which a compounded medication should be submitted to a Pharmacy Benefit Manager (PBM) for reimbursement. Previously, the requirement was to only list the most expensive ingredient, with reimbursement being made based on that line item. With the change,…
In previous articles, we have discussed some of the general law enforcement related activities that OIG Special Agents conduct; search warrants, arrests, HHS Secretarial Protection assignments and drug diversion investigations. Even with all of that being said, people still wonder about instances when an OIG Agent might have had to otherwise exercise law enforcement authority. …