COMMERCE CITY, Colo. — In her 19 years of living with cerebral palsy, scoliosis and other ailments, Cynthia Enriquez De Santiago has endured about 60 surgeries and her heart has flatlined at least four times. But the most unusual doctor’s referral of her life came last year: Go see an attorney. Enriquez De Santiago sought…
In this episode of Retro Fraud, Eric brings Matt Lawhon back for another great discussion. Since Matt has a unique background as both a healthcare fraud investigator, and now as a healthcare lawyer, Eric brought Matt back for some continued discussions on fraud, waste and abuse (FWA). Matt and Eric discuss ambulance fraud, and the…
When the coronavirus hit Martha Leland’s Connecticut nursing home last year, she and dozens of other residents contracted the disease while the facility was on lockdown. Twenty-eight residents died, including her roommate. “The impact of not having friends and family come in and see us for a year was totally devastating,” she said. “And then,…
In episode 3 of the Retro Fraud Podcast, Eric engages in a really interesting case discussion with Matt Lawhon. Matt, who is currently a healthcare attorney in the Dallas area (M B Lawhon Law Firm, PLLC), spent a number of years both as an investigator for a Medicare contractor and as a sworn law enforcement officer for the State of Texas Medicaid Fraud Control Unit.
Matt discusses a really interesting case involving a hearing fraud scheme; only covered by Medicaid, but involved a substantial amount of money, identity theft and healthcare fraud.
The investigative results will shock you.
-->In episode 3 of the Retro Fraud Podcast, Eric engages in a really interesting case discussion with Matt Lawhon. Matt, who is currently a healthcare attorney in the Dallas area (M B Lawhon Law Firm, PLLC), spent a number of years both as an investigator for a Medicare contractor and as a sworn law enforcement officer…
Pharma companies often cover the cost of patient copays for expensive drugs under private health ins. A federal judge could make the practice legal for millions on Medicare as well.
Actual Loss is defined as “reasonably foreseeable pecuniary harm that resulted from the offense.” Intended Loss is defined as “the pecuniary harm that the defendant purposefully sought to inflict.” For us that do not have a law degree, what does this all mean? In the federal criminal system, a defendant’s potential prison exposure is based…
We provide a lot of advisory and consulting services for the legal community. Our Former HHS-OIG Special Agents have that very niche experience in the ability to speak healthcare fraud, waste and abuse as well as legalese. In working with the various law firms on criminal, civil and administrative matters, it becomes clear that having…
Here is the scenario: a provider sells a large, and very profitable practice to another provider looking to either establish themselves in an area or grow an existing practice to another location or expanded patient base. The types of law firms we see that analyze the value of a provider for mergers and acquisition include lawyers…
This week’s Fraud Spotlight features guest contributor Mark R. Brengelman, JD, MA. Be sure to tune into the column for more expert insights from our network of providers, investigators, and fraud experts. This article begins a multi-part series covering the top ten violations of law against physical therapists that are enforced by state licensure boards against these health care…
This week’s Fraud Spotlight features guest contributor Mark R. Brengelman, JD, MA. Be sure to tune into the column for more expert insights from our network of providers, investigators, and fraud experts. This article rounds out lessons in dental misconduct involving fraudulent billing, medical records forgery/lack of documentation, and standard of care from a case in real…
