by Chia Gemmato | Oct 27, 2023 | Healthcare, Healthcare Law, OIG Files
After glancing at the Halloween-themed graphic, I was tempted to rename this blog “The ‘Fraid’ Hunter” because that picture is horrifying. However, it did inspire me to discuss a healthcare horror tragedy. In this story, there are no bad guys,...
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...
by Advize Admin | Feb 17, 2023 | OIG Files
“After 11 months of largely sitting alone in his room undergoing what the hospital called “Chair Therapy” (sit and think about your life) he left that hospital a broken teenager.” Return on investment is a calculation that Special...
by Advize Admin | Jan 20, 2023 | OIG Files
We work very closely in the payor and provider space to ensure that fraud, waste, abuse (FWA) and compliance are at the forefront of the payment integrity continuum. This is particularly the case when working to conduct medical record reviews and identify over...
by Advize Admin | Dec 2, 2022 | Compliance, FWA, Medical Record Auditing, OIG Files
When you first open this article, the most glaring of things is the time frame from which the audit was derived. 2011-2013 data is at this point so aged, the calculation of $1,000 per patient enrolled in a Medicare Advantage (MA) as the overcharged amount is simply...
by Advize Admin | Oct 21, 2022 | OIG Files
This week’s round up from Eric Rubenstein, our very own Sr. Director of FWA and Litigation. Pharmacist Convicted for Health Care Fraud and Black-Market Prescription Drug Diversion Scheme This case comes right out of our very own Wade McFaul’s old...
by Advize Admin | Oct 7, 2022 | OIG Files
We are proud to bring a new fashion of fraud your way. You might ask yourself, what is the difference between Vintage, Antique, and Retro? Let’s start here, vintage is something that is too old to be considered used and is often related to past pop culture, junk...
by Advize Admin | Sep 8, 2022 | FWA, OIG Files
Open enrollment will be upon us in the coming month. With it will come a slew of fraud complaints as it relates to managed care enrollment. Brokers work to enroll eligible members into plans that are supposed to be the best suited for the member. ...
by Advize Admin | Sep 2, 2022 | OIG Files
Boca Raton Chiropractor Sentenced To Four Years’ Imprisonment For $20 Million Health Care Fraud Scheme Straw ownership is a huge challenge in healthcare fraud investigations. The creation of shell companies and nominal owners obscures the true ownership and thus, the...
by Advize Admin | Aug 26, 2022 | Commentary, OIG Files
A phrase that does not often come up is “medical loss ratio,” or MLR. As an OIG Agent, I spent very little time looking at the OIG Workplan (I’ve blogged and spoken about how OIG Agents follow the current frauds, and how the plan is very much used to direct the work...
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