In this episode of Retro Fraud, Eric has an engaging discussion with Karen Weintraub. Those of you in the FWA space will know Karen as the face of Healthcare Fraud Shield. Eric and Karen have been professional and personal friends for 20 years and had a great discussion about how the human element is an absolute necessity to compliment artificial intelligence and data analytics in ferreting out false positives and false negatives in claims data.
2021-08-27: Hello! This is the new home of the RFP. We are in the process of switching to a different format and updating all platforms with the latest episodes. We should have that completed in the next few days. In the meantime if you are looking for Episodes 2, 3 and 4 please go check out the RFP playlist on the Advize YouTube channel. Also subscribe if you would like updates when a new episode goes live.
In this episode of Retro Fraud, Eric spends some time with former Deputy Chief of the Health Care and Government Fraud Unit and long-time Assistant United States Attorney Joe Mack (Joseph G. Mack).
Joe is now in the private sector, working in regulatory and compliance for healthcare, but spent a number of years as a criminal prosecutor in the US Attorney’s Office in New Jersey, on healthcare fraud matters.
Eric and Joe worked together for many years, punctuated by the Orange Community MRI case. That case resulted in about 20 prosecutions, including 17 criminal prosecutions, and three trials in 14 months. Eric and Joe discuss this overall case, the facts and prosecutorial decisions that are made and how kickbacks continue to be a problem in the healthcare world.
In this week’s episode of Retro Fraud, Eric speaks with Attorney Lisa Taylor. Lisa is an extremely experienced healthcare regulatory, transactional and compliance lawyer. Eric and Lisa worked together on the federal monitorship of the University of Medicine and Dentistry of New Jersey (UMDNJ).
UMDNJ was the first state operated organization to be subject to a deferred prosecution agreement (DPA). That DPA included the installation of a federal monitor to oversee many of the compliance issues that were uncovered during the investigation that led to the DPA. Lisa was the main point of contact for the monitor, and Eric was the OIG case agent on all of the cases that evolved from that monitorship. Eric and Lisa have a great discussion about those cases and the importance of good corporate citizenship.
In this episode of Retro Fraud, Eric brings Matt Lawhon back for another great discussion. Since Matt has a unique background as both a healthcare fraud investigator, and now as a healthcare lawyer, Eric brought Matt back for some continued discussions on fraud, waste and abuse (FWA).
In this episode, Matt and Eric discuss ambulance fraud, and the broader policy related issues of emergency and non-emergency transports, particularly in the skilled nursing home setting. Please enjoy this informative look back-and forward, at the ongoing fraud schemes.
In episode 3 of the Retro Fraud Podcast, Eric engages in a really interesting case discussion with Matt Lawhon. Matt, who is currently a healthcare attorney in the Dallas area (M B Lawhon Law Firm, PLLC), spent a number of years both as an investigator for a Medicare contractor and as a sworn law enforcement officer for the State of Texas Medicaid Fraud Control Unit.
Matt discusses a really interesting case involving a hearing fraud scheme; only covered by Medicaid, but involved a substantial amount of money, identity theft and healthcare fraud.
The investigative results will shock you.
As we hit the ground running on our second episode of Retro Fraud, Eric interviews Wade McFaul, a retired HHS-OIG Supervisory Special Agent, who worked out of the Los Angeles Field Office.
Wade now works with Advize as the Director of Special Projects and Investigations. Wade is a wealth of knowledge and in this second episode, Wade and Eric discuss identity theft, check fraud, money laundering and how that all worked to create a huge healthcare fraud organized crime group.
Join former HHS-OIG Special Agent and Advize Director of Litigation, FWA Support, Eric Rubenstein, as he engages with fellow retired HHS-OIG Senior Special Agent Peggy Glynn.
Peggy spent over 28 years in the Buffalo, NY Field Office. Eric and Peggy tackle a discussion of a large, national case involving in-patient and out-patient claims that were fraudulently submitted to Medicare and other payors, relative to a spinal surgical procedure. This inaugural episode of Retro Fraud is one not to miss.