A new rule took effect recently that requires commercial payors to provide reimbursement for in-home COVID-19 testing, at a rate of eight (8) test kits per person, per month. Although well intended, the process for seeking reimbursement from commercial payors will be an utter disaster. It is noted that government payors are excluded from this,…
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…
This week our commentary on our favorite articles. We are excited to see that the issues we know are important are becoming more mainstream. A Florida chiropractor signed hundreds of mask exemption forms for students. Now, the district has tightened its mask policy (CNN) Without the political hyperbole, does a chiro signing off on mask…
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 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…
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…
Actual Loss is defined as “reasonably foreseeable pecuniary harm that resulted from the offense.” Intended Loss is defined as “the pecuniary harm that the defendant purposefully sought to inflict.” For us that do not have a law degree, what does this all mean? In the federal criminal system, a defendant’s potential prison exposure is based…
