Posted and filed under OIG Files.

OIG Files: The Mixing Bowl of Medication

In 2012, the National Council on Prescription Drug Programs (NCPDP) made a change to the manner in which a compounded medication should be submitted to a Pharmacy Benefit Manager (PBM) for reimbursement.  Previously, the requirement was to only list the most expensive ingredient, with reimbursement being made based on that line item.  With the change,…

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Posted and filed under OIG Files.

Yes, Virginia, OIG Special Agents Carry Firearms

In previous articles, we have discussed some of the general law enforcement related activities that OIG Special Agents conduct; search warrants, arrests, HHS Secretarial Protection assignments and drug diversion investigations.  Even with all of that being said, people still wonder about instances when an OIG Agent might have had to otherwise exercise law enforcement authority. …

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Posted and filed under FWA, Healthcare.
Posted and filed under Compliance.

The Corporate Practice of Medicine

Recently, we were contacted by the Chief Financial Officer (CFO) of a medical group that provides primary care, urgent care and podiatric care to patients at several locations. The business operates as a corporate practice of medicine. The CFO had no prior healthcare experience. The Chief Operating Officer (COO) also had no prior healthcare experience….

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Posted and filed under Fraud, FWA, Healthcare.

Fraud Spotlight: Detecting & Investigating FWA during COVID-19

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 hopefully are seeing the beginning of the end with COVID-19, but we will certainly not see…

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Posted and filed under Fraud, FWA, Healthcare.

Fraud Spotlight: Understanding the OIG’s Key Operating Divisions

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. When we speak to various people in our space looking to engage us in work that…

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Posted and filed under Fraud, FWA, Healthcare.

Fraud Spotlight: Recidivism & Sentencing in Healthcare Fraud

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.  Earlier in the week, this press release came out. We spent a lot of time looking through…

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Posted and filed under Dental, Fraud, FWA.

Fraud Spotlight: Why Dental Fraud is Overlooked & Ignored

Over the past few weeks, we have been blogging and posting about the “red-headed step-child” of healthcare fraud, dental fraud. One of our retired OIG agents recently heard this tale, which bears repeating: At a recent visit, his mother was told by the treating dentist that she had a gum infection and needed to see…

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Posted and filed under Dental, Fraud, FWA, Medical Record Auditing.

A Frank Discussion on Dental Fraud

Our Founder and Managing Director Jeanmarie Loria sat down with retired OIG Special Agent Eric Rubenstein to discuss dental fraud, unscrupulous dentists, and the claims-related intricacies of the dental industry. Here’s how it went… JL: My aunt in California paid an additional $10 for personal protective equipment (PPE) on top of her dental visit. Other members…

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Posted and filed under Dental, Fraud, FWA, Uncategorized.

Rinse & Spit: Investigating Dental Fraud

Next Week On The Blog: Jeanmarie Loria sits down with her partner Eric Rubenstein, retired OIG Agent, to ask him why he had more cases on pharmacy pain management and DME than dental fraud.  Dental fraud stinks worse than the most severe case of halitosis.    Picture this.   Brooklyn NY 1960. All 5 of…

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