Posted and filed under Compliance.

The Corporate Practice of Medicine

Recently, we were contacted by the Chief Financial Officer (CFO) of a medical group that provides primary care, urgent care and podiatric care to patients at several locations. The business operates as a corporate practice of medicine. The CFO had no prior healthcare experience. The Chief Operating Officer (COO) also had no prior healthcare experience….

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Posted and filed under Fraud, FWA, Healthcare.

Fraud Spotlight: Detecting & Investigating FWA during COVID-19

The Fraud Spotlight series is a long-form examination of current fraud trends and investigative strategies from our team of retired OIG agents and expert fraud investigators. Stay tuned for weekly insights, updates, and information on healthcare’s most expensive crimes. We hopefully are seeing the beginning of the end with COVID-19, but we will certainly not see…

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Posted and filed under Fraud, FWA, Healthcare.

Fraud Spotlight: Understanding the OIG’s Key Operating Divisions

The Fraud Spotlight series is a long-form examination of current fraud trends and investigative strategies from our team of retired OIG agents and expert fraud investigators. Stay tuned for weekly insights, updates, and information on healthcare’s most expensive crimes. When we speak to various people in our space looking to engage us in work that…

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Posted and filed under Fraud, FWA, Healthcare.

Fraud Spotlight: Recidivism & Sentencing in Healthcare Fraud

The Fraud Spotlight series is a long-form examination of current fraud trends and investigative strategies from our team of retired OIG agents and expert fraud investigators. Stay tuned for weekly insights, updates, and information on healthcare’s most expensive crimes.  Earlier in the week, this press release came out. We spent a lot of time looking through…

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Posted and filed under Dental, Fraud, FWA.

Fraud Spotlight: Why Dental Fraud is Overlooked & Ignored

Over the past few weeks, we have been blogging and posting about the “red-headed step-child” of healthcare fraud, dental fraud. One of our retired OIG agents recently heard this tale, which bears repeating: At a recent visit, his mother was told by the treating dentist that she had a gum infection and needed to see…

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Posted and filed under Dental, Fraud, FWA, Medical Record Auditing.

A Frank Discussion on Dental Fraud

Our Founder and Managing Director Jeanmarie Loria sat down with retired OIG Special Agent Eric Rubenstein to discuss dental fraud, unscrupulous dentists, and the claims-related intricacies of the dental industry. Here’s how it went… JL: My aunt in California paid an additional $10 for personal protective equipment (PPE) on top of her dental visit. Other members…

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Posted and filed under Dental, Fraud, FWA, Uncategorized.

Rinse & Spit: Investigating Dental Fraud

Next Week On The Blog: Jeanmarie Loria sits down with her partner Eric Rubenstein, retired OIG Agent, to ask him why he had more cases on pharmacy pain management and DME than dental fraud.  Dental fraud stinks worse than the most severe case of halitosis.    Picture this.   Brooklyn NY 1960. All 5 of…

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Posted and filed under Compliance, FWA, Healthcare, Payers.

Fraud Spotlight: Understanding Medicare as a Secondary Payer (MSP)

The Fraud Spotlight series is a long-form examination of current fraud trends and investigative strategies from our team of retired OIG agents and expert fraud investigators. Stay tuned for weekly insights, updates, and information on healthcare’s most expensive crimes.  Recently, we discussed a situation where Medicare may still pay for a service, item or procedure…

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Posted and filed under Fraud, FWA, Healthcare.

Fraud Spotlight: What We Can Learn From The Novartis Settlement

The Fraud Spotlight series is a long-form examination of current fraud trends and investigative strategies from our team of retired OIG agents and expert fraud investigators. Stay tuned for weekly insights, updates, and information on healthcare’s most expensive crimes. If you are keeping a scorecard on healthcare fraud prosecutions and settlements, you undoubtedly saw that…

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Posted and filed under Compliance, Fraud, FWA, Healthcare.

Fraud Spotlight: How Crises Can Impact Fraud Investigations

Retired OIG Special Agent and Advize’s Director of Litigation & FWA Support will be stepping in each week to examine current fraud trends from the lens of an investigator. Stay tuned for weekly insights, updates, and information on healthcare’s most expensive crimes. Hurricane Katrina and COVID-19, what do these two very different things have in…

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