When I was first hired as an OIG Agent, I was told by numerous people that fraud in the Medicare Advantage (MA) world was difficult to commit, and ever more difficult to prove. To put it into context, it was the mid-1990s, and MA plans were not where they are today. That being said, I always…
“Justice delayed is justice denied” by William Gladstone is a quote that comes to mind when I think about fraudulent providers and Elizabeth Holmes. I am obsessed with the podcast The Drop Out, featuring the trial of Elizabeth Holmes, and this week’s episode was released within days of the 600 pages of personal text messages…
The Justice Department has accused an upstate New York health insurance plan for seniors and its medical analytics company of cheating the government out of tens of millions of dollars. The civil complaint of fraud, filed late Monday, is the first by the federal government to target a data mining company for allegedly helping a…
The tagline from the CMS Website is “When Medicare Claims are submitted accurately, everyone benefits.” First – TPE why do we even care? Well, simple answer, it is a lovely little gift from CMS designed to help reduce claim denials and appeals through one-on-one help. As we can attest thorough masses of audits of provider…
We talk to you every week about trials and cases that are in our rearview mirror. Often what we worked on directly. Sometimes we talk about areas of interest like healthcare cost and changing policy. Sometimes we bring you best practices based on our clients. Well, step aside normal headlines. This week the Berny Madoff…
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 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…
A little background, one of areas where Advize provides consulting services is in the medical record review space. We have been providing this service to clients for over 20 years, both proactively, and reactively. Our CEO, Jeanmarie Loria, was actually a part of the development of the medical record review platform used by the Medicare contractors…
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 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…
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). Matt and Eric discuss ambulance fraud, and the…
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.
-->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…
