Posted and filed under Fraud, FWA, Healthcare.

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 here at Advize are always monitoring the press releases that are coming out of the various US Attorney’s Offices nationwide. Our team of retired OIG agents are always talking about the speed at which some of the recent prosecutions have occurred. As we have blogged about previously, healthcare fraud investigations are typically complicated and can take years to be resolved.  

The recent prosecutions exemplify a few things: the audacity by which some of these unscrupulous providers are acting is at a level that has not been seen in some time; the level of aggressive speed demonstrates that the fraud will be investigated and prosecuted vigorously. Audacity is nothing new to unscrupulous providers. We have all seen instances where after uncovering the scheme, it raised an eyebrow. As with the recent bout of frauds that have been uncovered, purchasing a bright orange sports car with the proceeds of a PPP loan should raise an eyebrow, but should not be a complete shock to anyone in the fraud, waste and abuse space. 

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What we at Advize are all encouraged by, is the amazing speed that all of those involved in the investigations have been able to come together in such a seamless manner. Obtaining documents, conducting field interviews, surveillance, serving subpoenas, and the entire back office type work done in an investigation take a lot of time. If you have worked in the law enforcement world, you know what we are talking about. If you are not directly involved in these types of investigations, you can certainly sympathize with the hurdles. 

It is a coordinated effort, and when the dust settles and the after-action analysis is completed, we all hope there are some new “best practices” that can be employed when the next 100-year virus occurs. 

Advize Health LLC is a healthcare advisory and consulting company that provides a breadth of healthcare industry services in the payer, provider, and legal communities. Contact our former OIG and Fraud Investigation team by emailing info@advizehealth.com for more information on our Fraud Spotlight series.