by Advize Admin | Oct 21, 2022 | Advize News, Compliance, Events
This week two of Advize Health’s own former HHS-OIG experts, Matt Kochanski and Wade McFaul presented a conversational webinar on Organized Fraud. Matt and Wade discussed their experiences with the types of fraud and various ways they investigated these cases. ...
by Advize Admin | Oct 14, 2022 | Advize News
Last week we shared that fraud is always in fashion and that our thesis was for emerging trends in healthcare fraud, like fashion, retro is where it is at – what is old is new and often fraud schemes are recycled over and over again. Our own Eric Rubenstein has been...
by Advize Admin | Oct 14, 2022 | Healthcare
It is the annual fall season of Medicare sales pitches and we have seen a rise in Celebrity Medicare Sales pitches. We are happy to see CMS creating tighter rules around the sales pitches and confusion. We have seen seniors fall victim to different Medicare...
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 30, 2022 | Compliance, FWA
Massachusetts has become the latest state to settle with health insurance giant Centene Corp. over allegations that it overbilled the state’s Medicaid program for pharmacy services, KHN has learned. Centene, the nation’s largest Medicaid managed-care insurer, will pay...
by Advize Admin | Sep 23, 2022 | FWA, Healthcare
Health insurance giant Centene Corp. has agreed to pay $165.6 million to Texas to resolve claims that it overcharged the state’s Medicaid program for pharmacy services. It’s the biggest known payout by the nation’s largest Medicaid insurer over its drug pricing...
by Advize Admin | Sep 2, 2022 | Advize News, Commentary
My Thursday started in Philly then Maryland, DC, Atlanta for a quick layover and then ended in Orlando. What a day! The highlight of that 5 city day was going back to Maryland again this week but only this time, the area was Fort Washington and some of 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...
by Advize Admin | Aug 12, 2022 | OIG Files
If you missed Eric opining on LinkedIn this week, here are some quick pieces of information including: an infectious disease doctor, a case in NJ, and a Bill that was signed into law. Another great case from my former OIG coworkers in NJ. This one should concern...
by Advize Admin | Aug 12, 2022 | Commentary
The National Association for Medicaid Program Integrity (NAMPI) Annual Conference brought us to Baltimore, MD just a few weeks after returning from Woodlawn, a neighboring area. It felt like the who’s who of the HHS-OIG greats and I felt lucky enough to spend a...
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