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…
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…
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…
When things don’t work out with your treatment, you can cry to your doctor or insurance, you can complain, but nothing will change. Similar to sitting on the tarmac for close to three hours because people were not available to unload bags from your plane. I should explain. Lately I have been looking at how…
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.
-->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…
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.
-->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…
