Retired OIG Special Agent and Advize’s Director of Litigation & FWA Support will be stepping in each week to examine current fraud trends from the lens of an investigator. Stay tuned for weekly insights, updates, and information on healthcare’s most expensive crimes.

This past week, I had the pleasure of presenting a webinar to approximately 700 physicians from around the United States.  The organization is a culturally based medical group of physicians with varying specialties.  This was both an exciting and challenging presentation, as not all the providers document, code or bill the same.  The additional challenge was the fact that it was not a traditional webinar; the slides were sent in advance to the membership as a PDF, and my comments were sent over a chat application that only allowed me to speak for a minute at a time before having to send the comments on the slide.

The focus of the presentation was on, of course, fraud, waste, abuse and compliance.  I spent most of the time discussing the importance of self-audits, and how doing them serves as a check and balance system to a practice.  I discussed the fact that doing self-audits helps providers to understand: (1) are they billing appropriately; (2) are they overbilling, and; (3) are they under billing.  I was not surprised to learn that many of the providers had no such check and balance system within their practices.  In fact, most of the providers who sent feedback were shocked to hear about the “war stories” of providers who did nothing to ensure correct billing was being done, and how, when faced with this situation, had to pay back so much more money than they initially received.

It brought to light the blog post I previously wrote, where I discussed the OIG’s difficulty in getting its messages out about who they are, and more importantly, the ramifications of inappropriate billing.  The members of this group were, in my estimation, truly unaware of these ramifications.  It was good to not only provide this education to the group, as a marketing, sales, and business development aspect of my role at Advize Health, but as a continued messenger of the mission of the OIG.  I encouraged the members of the group to strongly consider putting yearly (if not more frequently) a compliance plan in place (many had absolutely no compliance plan at all) that included self-audits.

I commended many of the providers who have contacted me about having Advize Health work with them to ensure compliance with Medicare and commercial billings rules and will always be a champion for the mission of the OIG.

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 Eric Rubenstein for more information on our Fraud Spotlight series.