For those of you who have been keeping up with the Elizabeth Holmes/Theranos trial, you likely have seen that there was a very mixed verdict. Holmes was convicted on some counts, acquitted on some and the jury was deadlocked on others. From a reader’s perspective, it can be confusing to understand how such a mix…
Vaccinate me. Vaccinate me, my friend. How many COVID tests does a person need in a 72 hours period? Well, I suppose it depends on where you are going, what you are doing and who requires it. Under the current laws, surveillance testing is not necessarily reimbursable by insurance or through the HRSA program for…
Former Pittsburgh-area Doctor Pleads Guilty to Unlawfully Prescribing Opioids in Exchange for Sex Unfortunately, this provider capitalized on his ability to prescribe controlled medications in other ways. By obtaining sexual favors from his patients, he was able to take advantage of his patients insatiable need for the drugs, and that the patient was willing to…
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.
-->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…
Close to 500,000 people are dead because of opioid overdoses in the USA from 1999 to 2019, according to the U.S. Centers for Disease Control and Prevention. Last week, we likened an overprescribing doctor to Elizabeth Holmes. This week, we are excited to see a groundbreaking settlement: The first settlement with a tribal government in the…
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…
What is most important: identify, eliminate, recover or (PLOT TWIST) prevent? Coming off of a strong week of meetings with my clients and listening to their real pain points coupled with listening to hours of the podcast Do You Know This Man, and incessant Elizabeth Holmes reading and consumption, I sit on my 6am flight…
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…
Thank you Scott Rosenbaum, Wine & Spirit Business Advisor, who is one of our most well read and insightful/thought provoking collaborator shared this New York Times article with us: Hospitals and Insurers Didn’t Want You to See These Prices. Here’s why. Scott is an experienced, process-driven strategist and educator working in the wine and spirits industry….
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…
