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

Last night, Advize Health had the opportunity to present before one of the largest chapters of its kind in the United States. The audience, comprised largely of credentialed medical coders and billers who assemble to discuss their professional and issues within the industry, were given the opportunity to explore healthcare fraud from two different perspective. This melding of the minds focused on two key themes:

What does healthcare fraud really look like?

How can compliance professionals contribute to its prevention?

In this interactive presentation, attendees were given the chance to ask their burning healthcare questions to two very different kinds of fraud fighters. Jeanmarie Loria, Advize Health’s Managing Director was one of two panelists. Ms. Loria has built her career around Program Integrity from a Payer perspective, with an emphasis on proactive provider education. The other panelist, Retired OIG Special Agent Eric Rubenstein, who had an illustrious career fighting fraud across the industry offered his insights to the attendees. One question sent ripples through the room, as many professionals can relate to the situation described.

“My boss, the provider, asks me to upcode.  I don’t want to lose my job, what should I do?”

The question isn’t an anomaly. Many medical coders, billers, and healthcare professionals have found themselves in the middle of a similar conflict. Mr. Rubenstein used his 20+ years of fraud fighting experience to engage with participants and answer questions just like the one above, while delving into his past investigations, Medicare and Medicaid Programs, and more. Prompted by Ms. Loria’s different perspective and the audience’s own experiences, Rubenstein took attendees through and exploration of health insurance from commercial to federal programs and included best practice for case management and investigations. Beyond the scope of a typical Q&A, the panelists discussed at the trends Rubenstein encountered from coast to coast, as well as a brief behind the scenes look at what happens after a fraudster is taken down.

Bottom line: Our least favorite thing about healthcare is the fraud. What about you? Let us know on LinkedIn, Facebook, Twitter, and Instagram.