robert

In the healthcare arena, compliance issues constantly arise, and especially when a crisis comes along.   COVID-19 is such a crisis, and one that has been enhanced from a compliance perspective by the Coronavirus Aid, Relief and Economic Security (CARES) Act, which released over $2.2 billion into the economy to various businesses, healthcare facilities, providers’ offices, […]

We have all heard the terms”health care fraud” and “health care abuse,” and most people realize it’s become a national issue that affects everyone, either directly or indirectly.   There are any number of estimates made on an annual basis as to how much money is truly lost to fraud and abuse in the U.S.Regardless of

CMS contracts with Medicare Advantage plans and private prescription drug plans to offer Part C and Part D managed care benefits to eligible beneficiaries. Federal law prohibits Medicare payments for services provided or prescriptions written by individuals or entities who are excluded from Federal health care programs when the plans know or have reason to know of the

In response to the COVID-19 pandemic, CMS implemented waivers and flexibilities that allowed Medicare beneficiaries to access a wider range of telehealth services without having to travel to a health care facility. We will analyze providers’ billing patterns for telehealth services. We will also describe key characteristics of providers that may pose a program integrity risk

Unfortunately, natural disasters represent a prime time for fraudsters to strike – with their multitude of schemes and scams – and during the period when people are likely most vulnerable.  During these times, most people aren’t thinking about fraud.  Government agencies aren’t either.  Their primary focus is onhelping people, as opposed to stopping fraudsters from

Since the advent of COVID-19, criminals across the globe have been exploiting the virus via a multitude of fraud schemes.  This has come to the attention of the FBI and other federal law enforcement agencies, including HHS/OIG.  Sadly, this fraud is so rampant that a recent report found that over $175,000,000 has already been scammed