by Advize Admin | Sep 8, 2023 | FWA, SIU
Referrals to law enforcement are just one of the ways that SIUs (Special Investigation Units) resolve cases. The number and relative importance of such referrals vary, but one thing is constant – the referrals should be reserved for only those cases where resolution...
by Advize Admin | Sep 1, 2023 | FWA, SIU
Data is great. Open-source information is helpful. Surveillance can provide insight. But nothing beats a good interview for getting to the heart of it. But what does it take to make it a good interview? In a word, what it takes is preparation. Preparation is...
by Advize Admin | Sep 1, 2023 | Compliance, Providers
Providers, are you aware that the Affordable Care Act (ACA), often referred to as “Obamacare,” mandates a compliance plan for those participating in Medicare and Medicaid? It’s surprising how many providers lack such a plan. This isn’t a...
by Advize Admin | Aug 18, 2023 | Commentary, FWA, Technology
In the short story “The Most Dangerous Game” by Richard Connell (and the movies based on the story), a big game hunter traps humans on an island because he is bored with hunting animals and wants, instead, to hunt “the most dangerous game,” humans. Well, with...
by Advize Admin | Aug 11, 2023 | Compliance, FWA
The biggest mistake a healthcare investigator can make is to forget what their mission is. It is not to solve a crime; it is to follow the facts to determine if a crime has been committed. Healthcare fraud investigative work is the opposite of detective work. A...
by Advize Admin | Aug 4, 2023 | Community, FWA
On a recent trip to South Florida, I came across some very interesting sights that gave me pause. The first was the combination of an Adult Day Care/Auto Garage, as pictured. The second was a similar combo of Home Health Care in the same storefront as a Guns/Ammo...
by Advize Admin | Aug 2, 2023 | Advize News
Scottsdale was hot AF (Hot As Fraud) – temperatures were way over 105, and hot Medicaid Fraud topics were discussed. The National Association for Medicaid Program Integrity (NAMPI) has an annual training conference. This conference brings together the public and...
by Advize Admin | Jul 28, 2023 | FWA, Medical Record Auditing
There is absolutely nothing in this report that should be interesting, shocking, or otherwise reflective of surprise. $784 million in improper payments is estimated to have been made to providers as it relates to COVID-19. Claims were submitted to the uninsured...
by Advize Admin | Jul 28, 2023 | Healthcare, Healthcare Law
The only government program that I can think of that did not authorize price negotiations for prescription medications was the Medicare Part D program. In its inception in 2006, price negotiations were not part of the law, and drug manufacturers were essentially at...
by Advize Admin | Jul 21, 2023 | Compliance, OIG Files
Every investigator knows that keeping your focus on the allegation is the key to efficiently conducting your investigation. There are times, however, when keeping those blinders on will result in the investigator not seeing the bigger picture. While investigating what...
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