Podcasts about health care fraud

Joe Wolfe, Attorney, Hall Render Killian Heath & Lyman PC, speaks with Laura Laemmle-Weidenfeld, Partner, Jones Day, about some of the key health care fraud and abuse trends from 2024 and what to expect in 2025. Laura is the author of the 2024 Cumulative Supplement to the Fifth Edition of AHLA's Legal Issues in Health Care Fraud and Abuse. From AHLA's Fraud and Abuse Practice Group.Watch the conversation here.AHLA's Health Law Daily Podcast Is Here! AHLA's popular Health Law Daily email newsletter is now a daily podcast, exclusively for AHLA Premium members. Get all your health law news from the major media outlets on this new podcast! To subscribe and add this private podcast feed to your podcast app, go to americanhealthlaw.org/dailypodcast.

What happens when your healthcare safety net becomes a web of confusion and denial? Drawing from a personal experience fraught with misdiagnosed pain and unexpected hospital visits, I unravel the hidden influence of insurance companies on critical medical decisions. After multiple trips to the emergency room, a diagnosis of gallstones finally emerged, but not before raising questions about the role of insurers in delaying necessary care. This episode also reflects on the recent passing of UnitedHealthcare's CEO, sparking a timely conversation about the often unseen impact of insurance policies on our health outcomes.We tackle the harsh reality faced by many who believe they're covered only to find themselves unprotected when it matters most. The emotional exhaustion and uncertainty caused by inadequate coverage demand immediate attention. We urgently call for transparency and accountability from healthcare insurers, recognizing the weight this bears on grieving families. By spotlighting the prevalence of insurance fraud and the need for clarity in coverage, we encourage listeners to examine their options closely, ensuring their healthcare plans truly serve their intended purpose. Prepare to rethink your approach to healthcare coverage and join us in advocating for honest and reliable insurance practices.Send us a textWe want to hear from you, Introduce yourself the way you would like it aired, where your calling from State and City is fine as well as which Season, Podcast title and episode. Call the Studio at 212-718-0330 and leave your comments Call the studio to respond 212-718-0330Support the showWhat part of the game is that. August 2022WhatPartOfTheGameIsThat.com, Wpotgit.com

My guest today on the Online for Authors podcast is Francine Pozner-Ehrenberg, author of the book America's Candidate. Francine is an attorney and the owner of Ehrenberg & Associates Consulting Group. She is the author of the suspense novel, “America's Candidate,” which is available on Amazon. Francine was a Major in the United States Army, Judge Advocate General's Corp. serving for over 12 years. During a deployment to Albania in the war-stricken Balkans, as part of Operation Cornerstone, she served as the advisory liaison between civilian officials and multinational military forces involved with the operation. Ehrenberg graduated from Rutgers Law School and is also a graduate of the Civil Affairs Advanced Course at the JFK Special Warfare Center and School at Fort Bragg. She has experience in Civil-Military Operations (CMO) and extensive work as a liaison between civil and military authorities in foreign international affairs. Additionally, she was an Assistant Prosecutor in Bergen County, NJ. She has handled numerous high-level, complicated Major Financial Crimes, Securities Fraud, Money Laundering, Medicaid Fraud, Health Care Fraud and Mortgage Fraud cases. In her book review, Tina Hogan Grant, guest-host for Online for Authors stated: America's Candidate was an enjoyable read written from multiple points of view which I liked. Each character was well defined and had their own unique voice. I found the synopsis for this book intriguing and wanted to know if Annie and Amir's idea would be successful. What I didn't expect, were the many twists and surprises along the way which added to the story. This was the author's debut novel and I think she did extremely well. I'm looking forward to her next one.  Subscribe to Online for Authors to learn about more great books! https://www.youtube.com/@onlineforauthors?sub_confirmation=1 Join the Novels N Latte Book Club community to discuss this and other books with like-minded readers: https://www.facebook.com/groups/3576519880426290   You can follow Author Francine Pozner Ehrenberg IG: @enrenberg_author All Author: allauthor.com/author/ehrenberg1/ Goodreads: www.goodreads.com/book/show/211030608-america-s-candidate X: @jagdag33   Purchase America's Candidate on Amazon: Paperback: https://amzn.to/40hHRDL Ebook: https://amzn.to/3ArCwiq   Teri M Brown, Author and Podcast Host: https://www.terimbrown.com FB: @TeriMBrownAuthor IG: @terimbrown_author X: @terimbrown1   #francinepoznerehrenberg #americascandidate #politicalfiction #mystery #terimbrownauthor #authorpodcast #onlineforauthors #characterdriven #researchjunkie #awardwinningauthor #podcasthost #podcast #readerpodcast #bookpodcast #writerpodcast #author #books #goodreads #bookclub #fiction #writer #bookreview *As an Amazon Associate I earn from qualifying purchases.

Joe Wolfe, Attorney, Hall Render Killian Heath & Lyman PC, speaks with Marissel Descalzo, Partner, Tache Bronis and Descalzo PA, about the current landscape of health care fraud settlements and enforcement activity. They discuss what triggers a false claim and accompanying investigation, what drives whistleblowers, patterns with respect to false claims cases, examples of recent enforcement actions, areas the Department of Justice is targeting, future enforcement trends, and OIG's November 2023 compliance program guidance document. They also discuss the second edition of AHLA's publication, Health Care Fraud Settlement Index. From AHLA's Fraud and Abuse Practice Group.Watch the conversation here.To learn more about AHLA and the educational resources available to the health law community, visit americanhealthlaw.org.

Data is a big driver of a lot of cases. In this episode, Captain Integrity Bob Wade breaks down the press release and results from the Criminal National Health Care Fraud Enforcement Action in 2024 with Jillian Willis, Partner at Nelson Mullins. Hear how data analytics remain at the forefront of detecting and prosecuting healthcare fraud, why criminal healthcare fraud enforcement remains a priority for the DOJ (Department of Justice), the importance of having a good culture of compliance, what is considered fraud, and when healthcare fraud is considered a crime. Learn more at CaptainIntegrity.com

This is a recap of the top 10 posts on Hacker News on June 27th, 2024.This podcast was generated by wondercraft.ai(00:41): Remembering Larry Finger, who made Linux wireless workOriginal post: https://news.ycombinator.com/item?id=40812695&utm_source=wondercraft_ai(01:52): Google Sheets ported its calculation worker from JavaScript to WasmGCOriginal post: https://news.ycombinator.com/item?id=40808820&utm_source=wondercraft_ai(03:06): 200 people charged in $2.7B health care fraud crackdownOriginal post: https://news.ycombinator.com/item?id=40815139&utm_source=wondercraft_ai(04:20): A modern 8 bit design, built using 1950s thermionic valvesOriginal post: https://news.ycombinator.com/item?id=40814011&utm_source=wondercraft_ai(05:36): Lessons I Wish I Had Been Taught (1996) [pdf]Original post: https://news.ycombinator.com/item?id=40808933&utm_source=wondercraft_ai(06:53): Eplot: A new package for making charts in EmacsOriginal post: https://news.ycombinator.com/item?id=40807923&utm_source=wondercraft_ai(08:02): Supreme Court blocks controversial Purdue Pharma opioid settlementOriginal post: https://news.ycombinator.com/item?id=40813369&utm_source=wondercraft_ai(09:13): Gemma 2: Improving Open Language Models at a Practical Size [pdf]Original post: https://news.ycombinator.com/item?id=40810802&utm_source=wondercraft_ai(10:31): Python grapples with Apple App Store rejectionsOriginal post: https://news.ycombinator.com/item?id=40815130&utm_source=wondercraft_ai(11:42): CriticGPT: Finding GPT-4's mistakes with GPT-4Original post: https://news.ycombinator.com/item?id=40812622&utm_source=wondercraft_aiThis is a third-party project, independent from HN and YC. Text and audio generated using AI, by wondercraft.ai. Create your own studio quality podcast with text as the only input in seconds at app.wondercraft.ai. Issues or feedback? We'd love to hear from you: team@wondercraft.ai

President Joe Biden and former President Donald Trump are hours away from are making their pitch to voters in the first presidential debate of the 2024 cycle. A massive roaming outage is leaving some customers traveling internationally in the dark. Hundreds of Palestinians evacuated a neighborhood in an eastern Gaza city amid overnight Israeli strikes. This week, the Justice Department announced charges against nearly 200 people accused of participating in health care fraud schemes. Plus, scientists are looking to one of nature's most dangerous and destructive forces to relieve the world's worst mass cloral bleaching event. Learn more about your ad choices. Visit podcastchoices.com/adchoices

They admit to sending fake reimbursement claims to the state's Medicaid program for services they never provided.See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

In this third and final installment of Ropes & Gray's three-part podcast series exploring recent regulatory, compliance, and enforcement developments in the fraud, waste, and abuse space and the potential implications for health care and life science companies in 2024, health care partners Devin Cohen and Michael Lampert reunite with litigation & enforcement partner Andrew O'Connor for a conversation on key enforcement developments concerning the Medicare Advantage (“MA”) program, as well as the Department of Justice's (“DOJ's”) current enforcement trends regarding providers, labs, and electronic health record (“EHR”) companies. Additionally, their discussion covers two recent Supreme Court cases under the False Claims Act (“FCA”) and explores their potential impact on the health care industry moving forward. 

In this second installment of Ropes & Gray's three-part podcast series exploring recent regulatory, compliance, and enforcement developments in the fraud, waste, and abuse space and the potential implications for health care and life science companies in 2024, health care partners Devin Cohen and Michael Lampert are joined by litigation & enforcement partner Andrew O'Connor for a conversation on remuneration offered and paid by labs. Topics of discussion include an exploration of the permissibility of specimen processing arrangements, and an examination of overlay between the Office of the Inspector General (“OIG”) advisory opinions and Department of Justice (“DOJ”) enforcement actions.

Join Ropes & Gray's attorneys for a three-part podcast series exploring recent regulatory, compliance, and enforcement developments in the fraud, waste, and abuse space and the potential implications for health care and life science companies in 2024. In this first installment, health care partners Devin Cohen and Michael Lampert discuss key considerations for understanding recent advisory opinions published by the U.S. Department of Health and Human Services (“HHS”) Office of the Inspector General (“OIG”), as well as their scope and implications. With particular focus on advisory opinions concerning beneficiary inducements to patients, this episode examines Anti-Kickback Statute and Civil Monetary Penalties Law concerns with such arrangements, as well as factors OIG has deemed to alleviate such concerns in the advisory opinions it issued in the past year. 

The Office of Inspector General (OIG) recently issued an updated General Compliance Program Guidance.  This is an important area of compliance that all dental offices need to be aware of.  It includes fraud, waste and abuse as well as HIPAA. Tune into this episode to ensure your practice is up-to-date. OIG General Compliance Program Guidance: https://oig.hhs.gov/documents/compliance-guidance/1135/HHS-OIG-GCPG-2023.pdfFree HIPAA Assessment Tool: https://www.healthit.gov/topic/privacy-security-and-hipaa/security-risk-assessment-tool https://www.thecompliancedivas.com

Joe Wolfe, Attorney, Hall Render Killian Heath & Lyman PC, speaks with Laura Laemmle-Weidenfeld, Partner, Jones Day, about some of the key health care fraud and abuse trends from 2023 and what to expect in 2024. Laura is the author of the 2023 Cumulative Supplement to the Fifth Edition of AHLA's Legal Issues in Health Care Fraud and Abuse. From AHLA's Fraud and Abuse Practice Group.Watch the conversation here.To learn more about AHLA and the educational resources available to the health law community, visit americanhealthlaw.org.

NBA Health Care Fraud from Former Players - November 17th, 2:45 p.m.Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy

Reese, Pam and Alex discuss how Reese plans to celebrate his birthday, the criticism Eric Bieniemy has received and the latest in the ACC, SEC and other college conferences. Over the past few weeks, there has been a lot of talk about college conference realignment. What's going on in the ACC, SEC and other college conferences? Will Cal and Stanford be joining the Atlantic Coast Conference? Will any ACC teams leave the conference? How will Reese celebrate his birthday? Washington Commanders Offensive Coordinator Eric Bieniemy too hard? What should people think about Commanders head coach Ron Rivera's public criticism of OC Eric Bieniemy? Is Bieniemy being too intense with his players or are the Commanders players too soft? 18 ex-NBA players were charged in a $4M health care fraud scheme. Former Memphis Grizzlies guard Tony Allen was among the 18 players. What happened?

Joe Wolfe, Attorney, Hall Render Killian Heath & Lyman PC, speaks with Crane Pomerantz, Member, Clark Hill LLP, about trends and developments related to recent health care fraud settlements, including the key drivers of False Claims Act (FCA) settlements, the Department of Justice's February 2023 report on FCA settlements, criminal pleas, and reverse false claims cases. They also discuss AHLA brand-new publication, Health Care Fraud Settlement Index. From AHLA's Fraud and Abuse Practice Group.Watch the conversation here.To learn more about AHLA and the educational resources available to the health law community, visit americanhealthlaw.org.

Rene Thomas Folse, JD, Ph.D. is the host for this edition which reports on the following news stories: Top Court Says Employers Not Liable for COVID Spread to Family Members. Stay of Litigation Mandated During Appeal of Denial of Arbitration Motion. Cal/OSHA May Amend Citations Before, During and After ALJ Hearings. Money Launderer Convicted in Multi-Million Dollar Premium Fraud Scheme. SoCal Chiropractor Among 78 Charged in $2.5B in Health Care Fraud. Bay Area Construction Companies Charged with Premium Fraud. Jury Convicts San Jose Doctor For Illegal Opioid Prescribing. Jury Finds DME Company Owner Guilty of $24M in Fraudulent Claims. Cal/OSHA Cites The Two Employers of Seven Mass Shooting Victims. 2023 Survey of 18,000 Nurses Shows 30% Leaving Career.

Wednesday June 28, 2023 Biden CMS Granting Health Care Fraud Waivers

ZIFL - 6-15-2023 - Volume 27, Issue 12 The Source For Insurance Fraud Professionals This, the Twelfth issue of the 27th year of publication Zalma's Insurance Fraud Letter provides multiple articles on how to deal with insurance fraud in the United States. The issue begins with: Restitution Order Can't Be Discharged in Bankruptcy After Frayba Tipton and William Tipton pled guilty to committing insurance fraud, they were ordered to pay victim restitution to Nationwide Insurance Company of America (Nationwide). The trial court granted Nationwide's petition and entered civil judgments against the defendants. In Nationwide Insurance Company Of America v. Frayba Tipton et al., C095606, California Court of Appeals. See the full issue at http://zalma.com/blog/wp-content/uploads/2023/06/ZIFL-06-15-2023.pdf More McClenny Moseley & Associates Issues This is ZIFL's eighth installment of the saga of McClenny, Moseley & Associates and its problems with the federal courts in the State of Louisiana and what appears to be an effort to profit from what some Magistrate and District judges indicate may be criminal conduct. See the full issue at http://zalma.com/blog/wp-content/uploads/2023/06/ZIFL-06-15-2023.pdf Another Insurer Bites the Dust Friday Health Plans of Nevada faces the Nevada District Court to place it under regulatory supervision. See the full issue at http://zalma.com/blog/wp-content/uploads/2023/06/ZIFL-06-15-2023.pdf Bad News from The Public A new survey shows it's, like, totally cool to exaggerate damages on an insurance claim or, like, totally awesome to say you hurt yourself at work when you didn't. See the full issue at http://zalma.com/blog/wp-content/uploads/2023/06/ZIFL-06-15-2023.pdf Health Insurance Fraud Convictions Fifteen Year Sentence in $134 Million COVID-19 Health Care Fraud and Money Laundering Scheme Billy Joe Taylor, age 44, pleaded guilty to conspiracy to commit health care fraud and money laundering on October 27, 2022. According to court documents, Taylor and his co-conspirators submitted more than $134 million in false and fraudulent claims to Medicare in connection with diagnostic laboratory testing, including urine drug testing and tests for respiratory illnesses during the COVID-19 pandemic. See the full issue and dozens more convictions at http://zalma.com/blog/wp-content/uploads/2023/06/ZIFL-06-15-2023.pdf Florida Judge Slams SFR Contractor for Misrepresentation, Fraud in Tower Hill Case SFR Services, a Florida restoration firm made famous by its volume of claims litigation and its charges that United Property & Casualty Insurance Co. had instructed desk adjusters to alter their estimates, now finds itself in some legal trouble of its own. See the full issue at http://zalma.com/blog/wp-content/uploads/2023/06/ZIFL-06-15-2023.pdf Other Insurance Fraud Convictions Man Sentenced to Prison for Staged Arson and Insurance Fraud Denis Vladmirovich Molla falsely reported that his camper had been intentionally set on fire the 30-year-old Minnesota resident has been handed a 30-month prison sentence, followed by one year of supervised release, for filing fraudulent insurance claims related to a staged arson incident. See the full issue and more convictions at http://zalma.com/blog/wp-content/uploads/2023/06/ZIFL-06-15-2023.pdf The Baseball Card Scam This is a Fictionalized True Crime Story of Insurance Fraud from my experience as an Insurance Fraud Expert and is provided to explain why Insurance Fraud is a “Heads I Win, Tails You Lose” situation for Insurers. The story is true, only the names and places were changed to protect the guilty. Qui Tam and Insurance Fraud The qui tam portion of the California Insurance Frauds Prevention Act, like that in many other states, has a qui tam provision. (c) 2023 Barry Zalma & ClaimSchool, Inc. --- Support this podcast: https://podcasters.spotify.com/pod/show/barry-zalma/support

In this episode, Husch Blackwell's Meg Pekarske and Jonathan Porter, a former federal prosecutor, discuss takeaways from the recent American Bar Association's Annual National Institute on Health Care Fraud. Most importantly, they will explore what the hospice industry can expect after hearing the remarks of Lisa Miller, the Department of Justice's (DOJ) Deputy Assistant Attorney General who oversees the Criminal Fraud Section. According to Miller, data has shown an increase in costs to the Medicare program resulting from claims for hospice care. Therefore, combating health care fraud is going to be a top priority for the DOJ. Be sure to tune in for this important episode. You won't want to miss it.

Covid has exposed the corruption in the medical industry. We cannot live the greater of two evils and continue to believe our health care system is there to help us.    Check out WE are I Podcast on the following platforms:   YouTube https://www.youtube.com/channel/UCZWppHWKMs6DmXh-D3l1keQ   #Youtube   Podbean https://wearei.podbean.com/   #podbean   Apple Podcast https://podcasts.apple.com/ca/podcast/we-are-i/id1446212772   #applepodcast   Spotify https://open.spotify.com/show/4DIhJBkNrlfXUUKxf55tim   #spotify   IheartRadio https://www.iheart.com/podcast/269-we-are-i-81175585/   #iheartradio   Google Podcasts https://podcasts.google.com/search/we%20are%20i   #googlepodcasts   PlayerFM https://player.fm/series/2936500   #playerfm   Amazon Music  https://music.amazon.com/podcasts/b9310c4d-5b9f-4909-a43f-6d9c3956326f/we-are-i   #amazonmusic   Audible  https://www.audible.ca/pd/WE-are-I-Podcast/B08JJTLFTZ   #audible   Podchaser https://www.podchaser.com/podcasts/we-are-i-767711   #podchaser   Stitcher https://www.stitcher.com/show/we-are-i   #stitcher   Podcast Addict https://www.podcastaddict.com/podcast/3063321   #podcastaddict

Hello, and welcome to episode 55 of the Financial Crime Weekly Podcast, I'm your host, Chris Kirkbride. It's a bumper edition this week, with even a bit of a pick-up in the sanctions news. There are a couple of fraud reports out this week, and the Wolfsberg Group has published an update to it anti-bribery and corruption guidance. There's a bit on money laundering, and market abuse, and we end with the usual review of the week's cyber-attack news. Let's crack on. These are the links to the principal documents mentioned in the podcast: European Commission, Opening remarks by Commissioner McGuinness at the European Parliament plenary joint debate on crypto-assets.European Commission, Cyber: towards stronger EU capabilities for effective operational cooperation, solidarity and resilience.European Parliament, Bureau adopts first decision on strengthening transparency and accountability.European Parliament, REPORT on the proposal for a regulation of the European Parliament and of the Council on the prevention of the use of the financial system for the purposes of money laundering or terrorist financing (Report - A9-0151/2023).European Parliament, Stopping the flow of dirty money: Parliament ready for negotiations.European Parliament Legislative Observatory, Markets in Crypto-assets (MiCA).European Union Anti-Fraud Programme, Call for proposals.European Union, European Union Funding and Tenders Portal.European Union, European Union Funding and Tenders Portal Online Manual.Feedzai, The Human Impact of Fraud and Financial Crime on Customer Trust in Banks.FieldFisher, New package of UK Sanctions on Russia.International Association of Insurance Supervisors, Global Insurance Market Report, Cyber Special Topic Edition: Cyber.International Association of Insurance Supervisors, IAIS GIMAR special topic edition provides assessment of cyber risks in the insurance sector and financial stability implications (press release).Office of the Superintendent of Financial Institutions, OSFI releases new framework to strengthen financial institutions' resilience to cyber-attacks.Solicitors' Regulation Authority, Sanctions questionnaire.The Wolfsberg Group, Publication of the ABC Guidance (press release).The Wolfsberg Group, Wolfsberg Anti-Bribery and Corruption Compliance Programme Guidance.The Wolfsberg Group, Wolfsberg Anti-Bribery and Corruption Compliance Programme Guidance (Executive Summary).UK Department for Business and Trade, NTE 2023/07: sanctions against Russia introduced in April 2023.UK Finance, New figures show £177.6m was lost to impersonation scams in 2022 as take five to stop fraud issues warning to the public.UK Insolvency Service, Tough action taken against company directors for COVID-19 financial abuse (press release).UK Insolvency Service, Enforcement Outcomes 2022/23.UK Legislation, The Counter-Terrorism (Sanctions) (EU Exit) Regulations 2019 No 577.UK Legislation, The Russia (Sanctions) (EU Exit) (Amendment) Regulations 2023.UK National Crime Agency, SARs in ACTION.UK Office of Financial Sanctions Implementation, Financial Sanctions Notice: Counter-Terrorism (Domestic) (Nazem Ahmad).UK Office of Financial Sanctions Implementation, Financial sanctions: guidance (updated).UK Office of Financial Sanctions Implementation, Financial sanctions targets: list of all asset freeze targets.UK Office of Financial Sanctions Implementation, OFSI General Licence INT/2023/2883496 (Lithuanian Railways).UK Office of Financial Sanctions Implementation, High Value Dealer Guidance.UK Office of Financial Sanctions Implementation, Financial Sanctions Notice (21/04/23).UK Office of Financial Sanctions Implementation, Financial Sanctions Notice (Global Human Rights)(21/04/23).Ukraine government, УКАЗ ПРЕЗИДЕНТА УКРАЇНИ №227/2023.US Department of Justice, President of Metalhouse LLC Indicted for Sanctions Evasion and International Money Laundering.US Department of Justice, Brooklyn Federal Correctional Officer Charged with Bribery.US Department of Justice, Businessman Pleads Guilty to Bribing City of Atlanta and DeKalb County Officials to Obtain Contracts.US Department of Justice, Construction Company Owner Sentenced to 78 Months in Prison and Ordered to Pay Nearly $1 Million in Restitution for Rigging Bids and Bribing a Public Official.US Department of Justice, Former Venezuelan National Treasurer and Her Husband Sentenced in Money Laundering and International Bribery Scheme.US Department of Justice, Justice Department Announces Nationwide Coordinated Law Enforcement Action to Combat COVID-19 Health Care Fraud.US Department of the Treasury, Remarks by Assistant Secretary for Terrorist Financing and Financial Crime Elizabeth Rosenberg on DeFi Risk Assessment at the Atlantic Council.US Department of the Treasury Office of Foreign Assets Control, Treasury Sanctions Procurement Network Supporting Iran's UAV and Military Programs.US Department of the Treasury Office of Foreign Assets Control, Treasury Sanctions Three Nicaraguan Judicial Officials Involved in Human Rights Abuses.US Department of the Treasury Office of Foreign Assets Control, Treasury Disrupts International Money Laundering and Sanctions Evasion Network Supporting Hizballah Financier.US Securities and Exchange Commission, SEC Charges Crypto Asset Trading Platform Bittrex and its Former CEO for Operating an Unregistered Exchange, Broker, and Clearing Agency.

In this episode Sean breaks down the False Claims Act and the Health Care Fraud Statute. This is a very detailed breakdown of both laws with some insight to the proposed language change to the Medicare Voluntary Refund (60-Day Rule).

Zack Buck is an associate professor at the University of Tennessee College of Law. Stephen Morrissey, the interviewer, is the Executive Managing Editor of the Journal. Z. Buck. Fraud, Abuse, and Financial Conflicts of Interest. N Engl J Med 2023;388:673-676.

Matthew Wetzel, Partner, Goodwin Procter, speaks with Laura Laemmle-Weidenfeld, Partner, Jones Day, about some of the key health care fraud and abuse trends from 2022 and what to expect in 2023. Laura is the author of the recent supplement to the Fifth Edition of AHLA's Legal Issues in Health Care Fraud and Abuse. From AHLA's Fraud and Abuse Practice Group. Watch the conversation here.To learn more about AHLA and the educational resources available to the health law community, visit americanhealthlaw.org.

This episode is also available as a blog post: https://youarewithinthenorms.com/2023/01/07/from-chapman-law-group-dr-lesly-pompy-acquitted-of-all-38-counts-of-drug-trafficking-and-health-care-fraud/ --- This episode is sponsored by · Anchor: The easiest way to make a podcast. https://anchor.fm/app Support this podcast: https://anchor.fm/norman-j-clement/support

This episode is also available as a blog post: https://youarewithinthenorms.com/2022/08/04/ausa-wayne-f-pratt-chief-of-the-health-care-fraud-unit-us-attorneys-office-eastern-district-of-michigan-goose-stepping-in-the-boots-of-adolf-the-nazification-of-healthcare-and-a-case-of-s/ --- This episode is sponsored by · Anchor: The easiest way to make a podcast. https://anchor.fm/app Support this podcast: https://anchor.fm/norman-j-clement/support

By Adam Turteltaub The recently-released Health Care Fraud and Abuse Control Program FY 2021 report contains a treasure trove of information for healthcare compliance teams. To gain a better understanding of lessons to be learned from this document we sat down with SCCE & HCCA board member Gabe Imperato, Partner at Nelson Mullins. The report makes clear, he explained, how much coordination and review there is now among the Office of Inspector General at HHS, the US Department of Justice and also CMS. As a result, a subpoena, or even an inquiry needs to be taken very seriously. Compliance teams need to treat these external actions as if they are a report of non-compliant activity. The report also reveals that there has been an increase in cases based on failures of organizations to appropriately collect copays. Some organizations have taken egregious activity that could be characterized as ignoring the obligation. In other cases the provider has made what it considers to be a reasonable effort to collect the payment – asking at time of service, sending follow up letters – others think that more could be done such as calling patients and setting up a payment plan. With no clear definition of what's reasonable, the potential for a whistleblower case is high. The report also illuminates the challenges of Stark and Antikickback cases. In his opinion these cases makes it clear that if you are looking at a circumstances where on the one hand there is a potential source of business and on the other hand a potential source of revenue, and there is a financial relations between the two, it is best to bring in competent outside counsel to determine if there may be a violation of these highly complex laws. Kickback cases are very popular with qui tam attorneys, he notes, because of the difficulty in defending them completely. Looking to the future, Gabe sees a large number of Covid-related fraud cases that will likely take years to play out. Listen in to learn more, and be sure to read the report.

I had the privilege of sitting down with Mike Van Meter to discuss the many issues that are plaguing our profession. Mike has done it all, Navy Pilot, FBI agent, NA Instructor, course developer and now spends his time continuing to bring education,  awareness, and support to those struggling with addiction.  We talked about the importance of owning it, and more importantly, the importance of leadership to create an environment  of support and understanding. Pretending problems don't exist has never been a winning philosophy. Enjoy the episode, God Bless, John                                                                  MICHAEL L. VAN METER                                                  FBI Supervisory Special Agent (Retired) Mike received his Bachelor of Arts degree from the University of Florida in Political Science in 1988. At the time of graduation, he was also commissioned as an officer in the United States Navy, and served 8 years as a helicopter pilot. While in the Navy. Mike served as a Division Officer and Department Head of various units. While on active duty, he earned his Master of Arts degree from the University of Oklahoma in Human Relations in 1998. Mike also served as a Police Officer for the Metropolitan Police Department, Washington DC prior to entering duty with the FBI on January 3. 1999. He served in the Dallas Texas Division of the FBI where he investigated Health Care Fraud. Organized Crime, and Domestic Terrorism. Additionally. he served as a pilot flying surveillance missions in support of Dallas Division cases. While in the Dallas Division, Mike served as the case agent for several undercover operations.  In August of 2008. Mike transferred to FBI Headquarters where he served in the Domestic Terrorism Operations Unit as the Militia/Sovereign Citizens Program Manager. In June of 2010 he transferred to the FBI Academy at Quantico, Virginia where he taught new FBI Agents Interviewing and Interrogation techniques. Mike then became an instructor teaching Police Executives at the FBI National Academy beginning in 2011 where he taught Interviewing and Interrogation, Public Speaking. Officer Involved Shootings, and later created a course titled Leading At-Risk Employees. This course focuses on understanding alcoholism, prescription drug abuse, PTSD, suicide, and domestic violence as it relates to programs. policies, and procedures for law enforcement agencies. In order to teach these courses, Mike became an Adjunct Professor for the University of Virginia. He also served as the Employee Assistance Program Counselor and Coordinator for the FBI Academy Training Division.In January of 2017. Mike transferred to the National Joint Terrorism. Civil Aviation Security Program. In this capacity, he served as the Program Manager of over 450 Airport Liaison Agents located at federally controlled airports around the United States. Mike continued to serve as an EP Counselor and provided presentations regarding alcoholism and recovery nationwide. In July 2019. Mike retired from the FBI after 20 years of dedicated service. He recently started a new company called Van Meter Wellness Solutions LG to continue his passion for teaching on the subject of alcoholism and recovery, His vision is to educate the public on addiction, remove the stigma associated with addiction, and help those suffering from addiction achieve and maintain sobriety in order to live healthy and productive lives.http://www.vanmeterwellnesssolutions.com/

From Child Sex abuse to Serial murder, Mike Devine was the go to agent for the most difficult cases in NCIS. An expert interrogator, Mike knew how to connect and convince suspects to tell the truth. Mike had an amazing career with NCIS which ended far to quickly. Today Mike is still an investigator in world of Health Care Fraud.

Thursday May 19, 2022 Orthotic Brace Suppliers Convicted in $6.5 Million Health Care Fraud Case

Give us about ten minutes a day and we will give you all the local news, local sports, local weather, and local events you can handle.   SPONSORS: Many thanks to our sponsors... Solar Energy Services because solar should be in your future! The Kristi Neidhardt Team. If you are looking to buy or sell your home, give Kristi a call at 888-860-7369!  And- The Arts Council of Anne Arundel County! Today... Dr. Ron Elfenbein pleaded not guilty to counts of health care fraud charges. Hopkins ranked on the list of 25 most selective colleges. A non-binary option will be available to those runners at the Annapolis 10 Mile Run. Make sure to get your Chesapeake Bay Blues Fest tickets...And some pod news! Ann Alsina from CovingtonAlsina is here with your Monday Money Report! And as usual, George from DCMDVA Weather is here with your local weather forecast! Please download their APP so you can keep on top of the local weather scene! The Eye On Annapolis Daily News Brief is produced every Monday through Friday at 6:00 am and available wherever you get your podcasts and also on our social media platforms--All Annapolis and Eye On Annapolis (FB) and @eyeonannapolis (TW) NOTE: For hearing impaired subscribers, a full transcript is available on Eye On Annapolis  

US Attorney Bill Ihlenfeld On Health Care Fraud Sttrike Force by The Watchdog

In this episode of AHLA's monthly series on fraud and abuse issues, Matthew Wetzel, Partner, Goodwin Procter, speaks to Laura Laemmle-Weidenfeld, Partner, Jones Day, about some of the significant changes that have taken place in health law enforcement over the past year. They discuss changes to the Stark Law and Anti-Kickback Statute safe harbor for personal services arrangements, challenges related to telemedicine fraud enforcement, and DOJ's back-and-forth on the use of agency guidance documents in civil enforcement actions. Laura is the author of the recent supplement to the Fifth Edition of AHLA's Legal Issues in Health Care Fraud and Abuse. From AHLA's Fraud and Abuse Practice Group. Sponsored by BRG.

Eighteen former NBA players were charged Thursday with pocketing about $2.5 million illegally by defrauding the league's health and welfare benefit plan in a scam that authorities said involved claiming fictitious medical and dental expenses. According to an indictment returned in Manhattan federal court, the former players teamed up to defraud the supplemental coverage plan by submitting fraudulent claims to get reimbursed for medical and dental procedures that never happened.

Vover Hoops Insider Justine Brown brings you up to date on all of the latest news around the league including 18 former NBA players arrested by federal authorities in an alleged health care scam amounting to $4 million. She also takes a look at Kyrie's vaccine status and how Brooklyn will handle his situation this season if he remains unvaccinated. Justine ends by highlighting the incoming rookie class and picking out a few that have really impressed her so far this preseason. Host: Justine BrownAsk your questions about this episode or anything else on your mind by downloading the Vover app here!

(0:00) Zolak & Bertrand start the second hour with calls on Patriots-Texans, how Bill Belichick's tenure will end with the Patriots, and J.D. Martinez's injury. (9:07) We talk about how the Patriots defense was impacted by the news of Stephon Gilmore being dealt, as calls come in on Trent Brown and pain tolerance. (21:47) The guys react to 18 ex-NBA players being charged in a health care fraud scheme. (29:14) Beetle gives his review on “The Sopranos” prequel, “The Many Saints of Newark”.

Glen "Big Baby" Davis and Tony Allen, both on the 2008 Championship Celtics team, were two of those accused in the scheme. WBZ's Carl Stevens reports:

Monday May 17, 2021 Health Care Fraud Means Never Having to Say You're Sorry

A powerful documentary which exposed a vast healthcare fraud in Romania has been nominated for two Academy Awards. Collective, which opens in cinemas here this week, tells the story of a 2015 nightclub fire in Bucharest, which killed 27 and left 180 injured. When more burn victims start dying in hospitals from wounds that were non life-threatening, investigative journalist Catalin Tolotan uncovers shocking misconduct and fraud within Romania's health sector. When a new health minister is appointed, he offers unprecedented access to his efforts to reform the corrupt system. Kathryn Ryan speaks with journalist Catalin Tolotan and film director Alexander Nanau.

A powerful documentary which exposed a vast healthcare fraud in Romania has been nominated for two Academy Awards. Collective, which opens in cinemas here this week, tells the story of a 2015 nightclub fire in Bucharest, which killed 27 and left 180 injured. When more burn victims start dying in hospitals from wounds that were non life-threatening, investigative journalist Catalin Tolotan uncovers shocking misconduct and fraud within Romania's health sector. When a new health minister is appointed, he offers unprecedented access to his efforts to reform the corrupt system. Kathryn Ryan speaks with journalist Catalin Tolotan and film director Alexander Nanau.

The newest episode of MAG's Top Docs show featuring Scott Grubman addresses health care fraud and abuse and what steps physicians and allied professionals can take to avoid becoming the subject of a government investigation.

Chris is one of the top medical whistleblowers ever — and he's still at it. He owned and was CEO of a highly regarded Northern California lab testing company, Hunter Labs, until he was squeezed out of business by the predatory pricing scheme of the “Blood Brothers,” Quest and LabCorp. Their quid pro quo scheme, which involved loss-leader pricing to doctors and clinics to gain to their exclusive testing business, and then overcharging Medicare and Medi-Cal 20 to 40-fold, has cost taxpayers billions of dollars — and forced higher quality, but smaller labs like Hunter, either to fold or be absorbed by them. The Blood Brothers' scheme is one of the most nefarious in the medical fraud world that Chris fought to expose. Blood Money is the true legal thriller of a terrifying David vs. Goliath fight against massive healthcare fraud by a brave Whistleblower.  It includes attempted murder, extortion, money-laundering, fraudsters hiding money in the Cayman Islands, gold buried in a storage container in a CEO's backyard, an Assistant Attorney General sabotaging her state's case, and a corrupt Governor torpedoing litigation by his own Attorney General.  From Silicon Valley to the Sunshine State, in a showdown that reads like a Hollywood movie, Chris Riedel survives to share it all. His actions have resulted in more than $550 million in settlements and a court verdict

Brian Whisler is a long-time white collar practitioner at Baker McKenzie.  Brian joined me to discuss the new Biden Administration and the enforcement outlook from the Biden Department of Justice.  Brian has a unique perspective since he served as part of the DOJ transition in 2001 for the incoming Bush Administration. Brian has been a partner at Baker McKenzie for 12 years.  Prior to joining Baker McKenzie, Brian served for fifteen years as a federal prosecutor with the US Department of Justice. During that time, he was the Criminal Chief Assistant US Attorney in the Eastern District of Virginia, Richmond, overseeing and prosecuting cases ranging from white collar crime, violent crime, public corruption, and terrorism. His trial practice focused predominantly on white collar cases, including health care fraud, securities fraud, public corruption, money laundering and tax fraud. He previously served as an Assistant US Attorney for the Western District of North Carolina for ten years, where he focused on white collar prosecutions and received the Attorney General’s Award for his prosecutions in a money laundering investigation resulting in convictions of more than 25 defendants after three jury trials and multiple guilty pleas. Brian has extensive federal trial and appellate experience, having tried over 30 cases to verdict and argued more than 40 cases at the federal appellate level. He is experienced in handling a broad range of civil and criminal matters, including cases implicating the Foreign Corrupt Practices Act, False Claims Act, Anti-Money Laundering laws, Health Care Fraud, Securities Fraud, and Procurement Fraud. Brian has led multijurisdictional internal investigations and provided regulatory advice to multinational and domestic clients across many sectors, including oil and gas services, pharmaceuticals, financial services, manufacturing, and telecommunications. Additionally, he has developed compliance programs for Fortune 50 corporate clients, advised Boards and Audit Committees, guided companies and individuals in government investigations in multiple global jurisdictions and defended clients in criminal and civil litigation. He also represents companies and individual clients in investigations before multilateral institutions, including the World Bank, Asian Development Bank, the Inter-American Development Bank, as well as the US Agency for International Development, the United Nations, and the Global Fund.

In this episode of AHLA's monthly series on fraud and abuse issues, Matthew Wetzel, Associate General Counsel, Compliance Officer, GRAIL, speaks with Craig Freeman and Jerry Lewandowski, Berkeley Research Group (BRG), about artificial intelligence in health care. The podcast discusses how innovative tools can be used to root out compliance issues. From AHLA's Fraud and Abuse Practice Group. Sponsored by BRG.

"Fraud in the health care industry is a fact of life.  In 2016 alone, the federal government estimated that improper payments by Medicare and Medicaid totaled about $95 billion.  And that’s only a single year’s amount for just two of the government’s many health care programs.  With an aging population, increased health care spending, the passage of the CARES Act, and the government’s multi-trillion-dollar effort to mitigate the health and economic effects of the COVID-19 pandemic, health care fraud will only increase. Unfortunately, some of the readers of this article will be in the unenviable position of witnessing or even being asked to participate in billing and treatment frauds. Most will want to do the right thing and report it but will understandably be concerned about the effect on their careers. Rest assured, there are powerful laws in place to address this situation." Joseph Gentile is an attorney. He shares his story and discusses his KevinMD article, "Blowing the whistle on health care fraud: the rewards and protections of doing the right thing." (https://www.kevinmd.com/blog/2020/04/blowing-the-whistle-on-health-care-fraud-the-rewards-and-protections-of-doing-the-right-thing.html)

Rene Thomas Folse, JD, Ph.D. is the host for this edition which reports on the following news stories. More Lawsuits and Layoffs Follow Passage of AB-5 Employment Law, Privette Doctrine Precludes Security Guard's Suit, 10 NFL Players Charged with Health Care Fraud, Attorney Lee Mathis Pleaded Guilty - Sentenced to Lompoc, Mid-Wilshire Doctor to Pay $3.4M to Resolve Fraud Claim, Fake Doctor in Fake Long Beach Clinic Sentenced, East Bay Men Arrested for Fake Oxycodone Sales, The Broken FDA Drug Recall System, DWC Updates MTUS Drug List, WCIRB Quarterly Report Shows Escalating Premium Decreases.

This podcast is about the US Government's recent indictments of 10 former NFL players for health care fraud, wire fraud, and conspiracy. The former players, including Clinton Portis, are accused of submitting phony claims that led to $3.4 million in tax-free reimbursements. (1:23) Mike outlines the accusations and the scheme. (6:03) Ron Chapman of the Chapman Law Group has practiced health care fraud for 33 years and explains what the health care plan was, what the defenses of the players might be, how the punishment works, and his initial prediction of whether some of the former players will actually see prison time. (22:58) Mike provides his closing thoughts and predictions on this story.

The latest edition of the Medical Association of Georgia's (MAG) ‘Top Docs' show addresses federal health care fraud and abuse investigations – and it features Scott R. Grubman, who is a partner with the law firm of Chilivas, Cochran, Larkins & Bever LLP in Atlanta.

In today's Federal Newscast, the inspectors general for the Departments of Justice and Veterans Affairs are setting up a new VA health care fraud task force, to investigate and prosecute fraud within VA’s growing community care program.

Just like any other industry, the health care system is full of both good and bad actors. Fraudulent behavior might be happening right under your nose, and it impacts more than just your bottom line. Find out more in this episode of Blue Promise, featuring Ryan Zarfoss, formerly employed by the FBI and now serving as senior manager of special investigations at Blue Cross and Blue Shield of Texas. If you suspect fraud, there are ways to report it. Call our fraud hotline at 1-800-543-0867 or visit our website at bcbstx.com. Blue Promise is a podcast and online video blog that aims to address complicated health issues with candid conversations from subject matter experts. New editions are published regularly and are hosted by Dr. Dan McCoy, President of Blue Cross and Blue Shield of Texas. Watch the Blue Promise videos on YouTube at www.youtube.com/playlist?list=PL9…dyKd7TaJy-dM0iX7T.

We’ve all heard the horror stories of fraudulent behavior by business professionals across the country. But how common is it in the health care industry? Could it happen to you? The answers might scare you. Learn how to protect yourself in this episode of Blue Promise, featuring Ryan Zarfoss, formerly employed by the FBI and now serving as Senior Manager of Special Investigations at Blue Cross and Blue Shield of Texas. If you suspect fraud, there are ways to report it. Call our fraud hotline at 1-800-543-0867 or visit our website at bcbstx.com. Blue Promise is a podcast and online video blog that aims to address complicated health issues with candid conversations from subject matter experts. New editions are published regularly and are hosted by Dr. Dan McCoy, President of Blue Cross and Blue Shield of Texas. Watch the Blue Promise videos on YouTube at www.youtube.com/playlist?list=PL9…dyKd7TaJy-dM0iX7T.

  Dr. Lawrence F. Kobak, DPM, Esq., is Senior Counsel in Frier Levitt’s Healthcare Department, working in the Uniondale, New York office. Prior to joining Frier Levitt, Larry was a partner at Kern, Augustine, PC, and at Abrams, Fensterman, Eisman, Greenberg, Formato & Einiger, LLP where he was director of the firm’s Office of Professional Medical Conduct (OPMC) and Office of Professional Discipline (OPD) Defense.   Larry has extensive experience representing physicians in connection with licensure issues, as well as successfully defending physicians before Medical Boards, OPMC, OPD investigations, as well as Medicare Fraud, Fraud & Abuse, Hospital Actions, RAC Audits, Medicare Audits, OIG Fraud, Health Care Fraud, Medical Audits, and Health Plan Billing Audits. As a licensed Podiatrist prior to becoming an attorney, he served as the international president of the Academy of Ambulatory Foot and Ankle Surgery. Larry is a fellow of the Academy of Ambulatory Foot and Ankle Surgery, Diplomate of the American Board of Podiatric Surgery, Ambulatory Division, Diplomate of the American Board of Quality Assurance and Utilization Review Physicians, Diplomate of the American Academy of Pain Management, and Diplomate of the American Institute of Foot Medicine.   lkobak@frierlevitt.com 516.222.2400 Special Thanks to Editor, Baruch Kim, DO of BestDocz.com

Dr. Lawrence F. Kobak, DPM, Esq., is Senior Counsel in Frier Levitt's Healthcare Department, working in the Uniondale, New York office. Prior to joining Frier Levitt, Larry was a partner at Kern, Augustine, PC, and at Abrams, Fensterman, Eisman, Greenberg, Formato & Einiger, LLP where he was director of the firm's Office of Professional Medical Conduct (OPMC) and Office of Professional Discipline (OPD) Defense. Larry has extensive experience representing physicians in connection with licensure issues, as well as successfully defending physicians before Medical Boards, OPMC, OPD investigations, as well as Medicare Fraud, Fraud & Abuse, Hospital Actions, RAC Audits, Medicare Audits, OIG Fraud, Health Care Fraud, Medical Audits, and Health Plan Billing Audits. As a licensed Podiatrist prior to becoming an attorney, he served as the international president of the Academy of Ambulatory Foot and Ankle Surgery. Larry is a fellow of the Academy of Ambulatory Foot and Ankle Surgery, Diplomate of the American Board of Podiatric Surgery, Ambulatory Division, Diplomate of the American Board of Quality Assurance and Utilization Review Physicians, Diplomate of the American Academy of Pain Management, and Diplomate of the American Institute of Foot Medicine.  For more information: lkobak@frierlevitt.com 516.222.2400 Special Thanks to Editor, Baruch Kim, DO of BestDocz.com

  Dr. Lawrence F. Kobak, DPM, Esq., is Senior Counsel in Frier Levitt's Healthcare Department, working in the Uniondale, New York office. Prior to joining Frier Levitt, Larry was a partner at Kern, Augustine, PC, and at Abrams, Fensterman, Eisman, Greenberg, Formato & Einiger, LLP where he was director of the firm's Office of Professional Medical Conduct (OPMC) and Office of Professional Discipline (OPD) Defense.   Larry has extensive experience representing physicians in connection with licensure issues, as well as successfully defending physicians before Medical Boards, OPMC, OPD investigations, as well as Medicare Fraud, Fraud & Abuse, Hospital Actions, RAC Audits, Medicare Audits, OIG Fraud, Health Care Fraud, Medical Audits, and Health Plan Billing Audits. As a licensed Podiatrist prior to becoming an attorney, he served as the international president of the Academy of Ambulatory Foot and Ankle Surgery. Larry is a fellow of the Academy of Ambulatory Foot and Ankle Surgery, Diplomate of the American Board of Podiatric Surgery, Ambulatory Division, Diplomate of the American Board of Quality Assurance and Utilization Review Physicians, Diplomate of the American Academy of Pain Management, and Diplomate of the American Institute of Foot Medicine.   lkobak@frierlevitt.com 516.222.2400 Special Thanks to Editor, Baruch Kim, DO of BestDocz.com

Recently, the U.S. Department of Justice (DOJ) and Department of Health and Human Services (HHS) announced its largest ever national health care fraud takedown, resulting in charges against 601 diverse defendants including health care entities and individual providers. In this episode, Mark Rush and John Lawrence discuss some of the major trends of the takedown, including a focus on unlawful distribution of opioids and other prescription narcotics and a focus on holding individuals accountable, as well as practical takeaways from the takedown for those in the health care industry.  Presenter: Mark A. Rush and John H. Lawrence Download Presentation Materials

"Let's Talk FCA" is Crowell & Moring’s podcast covering the latest developments with the False Claims Act. In this episode, hosts Mana Lombardo and Jason Crawford interview Will Chang, a partner in the firm’s Health Care and White Collar & Regulatory Enforcement groups and a former trial attorney at the DOJ Criminal Division, Fraud Section, on health care fraud and FCA issues.

Federal Health Care Fraud Defense Lawyer Atlanta | Georgia White Collar Criminal Defense by WH Thomas Firm

January 2013 - This month we interview Rebecca S. Busch, RN, CFE, President and CEO of Medical Business Associates, a health care consulting, auditing and forensic services firm. She discusses health care fraud schemes, enforcement trends and strategies, and qualities she looks for in her investigative team.  

September 2017 - In this episode, health care fraud experts Jacqueline Bloink, CFE, CHC and Jerri Rowe, CFE, examine the high cost of health care fraud, not only in monetary terms, but in peoples’ well-being as well. They also discuss setting up their new health care group within the ACFE Community.

Health care fraud makes media headlines when it involves millions of dollars and impacts many organizations. However, individuals can be victims too – even with smaller cases that often go unnoticed. In this edition of Blue Promise, Dr. McCoy talks about the long term impact fraud can have on a patient’s medical records. Blue Promise is an online video blog that aims to address complicated health issues with candid conversations from subject matter experts. New editions are published regularly and are hosted by Dr. Dan McCoy, President of Blue Cross and Blue Shield of Texas. If you are interested in watching the Blue Promise videos, click the link below for a list of programs. www.youtube.com/playlist?list=PL9…dyKd7TaJy-dM0iX7T

The Justice Department Fraud Section recently revamped its website and it is quite an upgrade. I do not know when the Fraud Section did this update but as with the Evaluation of Corporate Compliance Programs document, it certainly was a soft launch. It appears the new site compiles several disparate sources of Fraud Section and Justice Department information into one website. Also, there looks to my eye to be some information posted on the Fraud Section website for the first time. In short, it is an excellent and most welcomed resource. A quick review of the site has a slide show of recent Justice Department resolutions scrolling across the screen. Go down to the bottom of the screen and you will see two very interesting documents, a 2015 and 2016 Fraud Section Year in Review. The FCPA Unit section includes such information as prior enforcement actions, Opinion Releases, other anti-corruption treaties and resources. There is also a list of Fraud Section leadership. However, the Fraud Section is made up of more than simply the FCPA unit and there are tabs for the following Health Care Fraud and Securities and Financial Fraud. Most interesting to me was the tab for the Strategy, Policy and Training Unit, which I have to admit, did not know was a part of the Fraud Section. The opening page for this Unit provides a description of its work. It is as wide ranging as international coordination and interaction with foreign prosecutors and investigators.  This new website revamp is a most welcomed resource for the compliance community. While it may be viewed as simply a compilation of other sites and locations within the greater Justice Department website by some; I believe the vast majority of compliance practitioners will find it a most welcomed compilation and resource. Learn more about your ad choices. Visit megaphone.fm/adchoices

The Justice Department Fraud Section recently revamped its website and it is quite an upgrade. I do not know when the Fraud Section did this update but as with the Evaluation of Corporate Compliance Programs document, it certainly was a soft launch. It appears the new site compiles several disparate sources of Fraud Section and Justice Department information into one website. Also, there looks to my eye to be some information posted on the Fraud Section website for the first time. In short, it is an excellent and most welcomed resource. A quick review of the site has a slide show of recent Justice Department resolutions scrolling across the screen. Go down to the bottom of the screen and you will see two very interesting documents, a 2015 and 2016 Fraud Section Year in Review. The FCPA Unit section includes such information as prior enforcement actions, Opinion Releases, other anti-corruption treaties and resources. There is also a list of Fraud Section leadership. However, the Fraud Section is made up of more than simply the FCPA unit and there are tabs for the following Health Care Fraud and Securities and Financial Fraud. Most interesting to me was the tab for the Strategy, Policy and Training Unit, which I have to admit, did not know was a part of the Fraud Section. The opening page for this Unit provides a description of its work. It is as wide ranging as international coordination and interaction with foreign prosecutors and investigators.  This new website revamp is a most welcomed resource for the compliance community. While it may be viewed as simply a compilation of other sites and locations within the greater Justice Department website by some; I believe the vast majority of compliance practitioners will find it a most welcomed compilation and resource. Learn more about your ad choices. Visit megaphone.fm/adchoices

Visit royshelburne.com for more information! From Roy, himself: Most dentists live in fear of litigation but few worry about going to prison. Nonetheless, I went to prison on August 20, 2008 and was released on May 14, 2010. If you'd like, take a deep breath, hold on, and take a ride with me through a health care providers worst nightmare. Take heart....there are ways to prevent what happened to me from happening to you. Born in Pennington Gap, VA, I was "raised" on a farm in rural southwest Virginia. Growing up there I learned to love the people and the scenery of the Appalachian Mountains. The second of 4 boys born to a High School agriculture teacher and a registered nurse, working on the farm instilled the importance of hard work. I'm deeply thankful to my parents for the example they set for me. I graduated from Pennington High School in 1973, with honors, and was accepted and enrolled at the University of Virginia, Charlottesville the fall semester of that same year. I was a 1977 graduate of the University of Virginia with a double major in Biology and Religious Studies.  I applied, was accepted to, and enrolled in the dental school at Virginia Commonwealth University and graduated with honors in 1981, 5th of 115. I returned home in 1981 to start my new practice in my grandfather's hardware store building. Serving organized dentistry as a former Secretary/Treasurer and President of the southwest Virginia, Component 6, Virginia Dental Association I learned the importance of giving back to the profession. I was honored to be been made a delegate to the Virginia Dental Association's Annual Meeting. I also learned the importance of volunteerism....giving back to my community, state, and world as I had been so richly blessed.  I have served for over 7 years with the various Mission of Mercy projects in Virginia and have been a member of a team of short term missionaries with the Baptist Medical Dental Missions International to Honduras, CA for 10 years. All this happened prior to the voluntary surrender of my dental license for revocation after the conviction and prior to sentencing. The criminal action began as an investigation by the Commonwealth of Virginia and the FBI in 2003 of the dental practice and myself. To this day, we still do not know what or who initiated the action. I was indicted in October of 2006 after evidence was presented twice to the Grand Jury in the western district of Virginia. I was tried in United States District Court for the Western District of Virginia, Roanoke Division in Abingdon. I was found guilty after a 9 day jury trial on March 6, 2008, of Health Care Fraud, Racketeering, Money Laundering, and Structuring. The money laundering convictions were set aside on July 1, 2008. On July 10, 2008, I was sentenced by the Honorable James P. Jones, of the Western District of Virginia to serve 24 months in Federal Prison with an additional 36 months of supervised probation. I am now serving the 36 month of supervised probation. During the sentencing, the prosecution presented witnesses and evidence to establish, support, and "demonstrate the amount of loss sustained by the victims as result of the offense”. Of the payments that I received during the six and a half years reviewed (payments in excess of three and a half million dollars) that loss was determined to be $17,889.57. In addition, I was ordered on March 6, 2008 to forfeit $200,000 as a result of the RICO and Structuring conviction. A penalty of $75,000 were ordered on July 10, 2008. The restitution represents "restitution to each victim in the full amount of each victim's losses”. The Government began an appeal of the decision in the criminal case; however, has since abandoned that appeal. The criminal case is now final as a matter law.  The government continued their attempts to again prosecute me and the practice via a civil complaint filed on November 6th, 2009.  That action was settled without going  to trial in February 2013.  The civil complaint was based on the same alleged course of action and claims as in the criminal action.  For the time being, there are no pending actions against me, but who knows how long that will continue to be the case?

Rene Thomas Folse, JD, Ph.D. is the host for this edition which reports on the following news stories. U.S. Supreme Court Lowers Standards for Health Care Fraud. Former State Senator Ron Calderon Pleads Guilty in Drobot Bribery Case. NBA Star Kermit Washington Pleads Not Guilty in Ron Mix Kickback Case. Orange County Doctor and Assistants Face Drug Trafficking Charges. Lien Claimants Must Use Uniform Assigned Name. Legislators Fight Drugmaker Anti-Generic Drug Tactics. TTD Rates to Increase Nearly 4% in 2017. DWC Issues Second 30-Day Comment Period for HOPD/ASC Fee Schedule. State Opioid Monitoring Programs Reduce Prescriptions by One-Third. Study Finds "Noticeable Decreases" in Workers' Compensation Opioid Prescriptions.

Health Care Fraud and False Claims I hosted 2 False Claims Act legal experts on this week’s MAG edition of Top Docs Radio. You’re going to want to check out what they have to say, as it could mean the difference between practicing medicine or not, in the end. Scott Grubman is a partner with […] The post Health Care Fraud and False Claims – Top Docs Radio appeared first on Business RadioX ®.

Retired Supervisory Special Agent Jim Wedick served in the FBI for nearly 35 years. In this episode of FBI Retired Case File Review, Jim is interviewed about his assignment as an undercover agent in the Bureau’s very first long-term undercover investigation. The case,  Major Case 1, was captioned OPFOPEN – short for Operation Fountain Pen.  The investigation marked a significant shift in FBI priorities and the first time the Bureau operated a sophisticated attack on organized crime networks, financial criminals and con-men using White-Collar Crime violations to prosecute off shore criminal enterprises. The case is the subject of a book, Chasing Phil by David Howard, and will be made in to a feature film. Jim mentions several other notable cases, including bribery case, – dubbed by the California media as “Shrimp Scam” – for which he received the Director’s Award in 1994 and a large Health Care Fraud case he supervised. We acknowledge his wife, retired special agent Nancy Wedick, who teamed up with his on several successful cases.

David L. Jimenez is the host for this edition which reports on the following news stories. Federal Judge Rejects NFL Settlement. National Nurses United Claims Medical Bills are Bloated with Waste. 2013 Was Record Year for Health Care Fraud. Profiteering and Fraud. Van Nuys DME Supplier Faces 30 Years After Guilty Plea. Orange County Attorney Jailed for Use of Cappers. SB 863 Roll Back Bill Dies An Early Death. Researchers Study Best Treatment for Herniated Discs. Researchers Link Chronic Back Pain and Brain Changes Causing Obesity. Analyst Predicts Third Wave of Asbestos Claims. NCCI Changes Experience Mod Rules in 36 States.

Kyle Uebelhardt is the host for this edition which reports on the following news stories. Supreme Court Sets Oral Arguments in Valdez Case. L.A. Deemed Nation's Hot Spot for Health Care Fraud. Final SB 863 Interpreter Regulations Now in Effect. OSIP Launches E-filing Portal for Self-Insured Public Agencies. Comp Industry Mulls Over Change to ICD-10. Study Says Fearful Doctors Order More Tests. Feds Advance Pay for Performance Fee Schedule. AIG Ends Stand-Alone Excess Comp Insurance.

Rene Thomas Folse, JD, Ph.D.is the host for this edition which reports on the following news stories. GAO Report Identifies Biggest Violators of Health Care Fraud. Insurance Commissioner Approves 2.8% Increase in Pure Premium Advisory Rate. DWC Posts Draft SB 863 Regulations to Implement the Lien Filing Fee. DWC Posts Draft SB 863 Interpreter and QME Regulations. SB 863 Architect Claims it is a "Game Changer." California Chamber of Commerce Publishes SB 863 Compliant Notices and Pamphlets. Janet Frank New PacificComp President and CEO

Rene Thomas Folse, JD, Ph.D.is the host for this edition which reports on the following news stories. Physiological Manifestations of Stress Limited by Good Faith Personnel Action Defense. Sacramento Comp Doctor Faces Retrial in Sexual Abuse Case. Federal Prosecutors See Medical Research As Emerging Trend in Health Care Fraud. DWC Posts SJDB, Physician Predesignation and Chiropractic PTP Regulations. DWC Approves SB 863 Updates to CWCI New Hire Pamphlets and Posting Notices for 2013. New Medicate Set-Aside Contractor Speeds Review Time to 30 Days. Study Says New Orthopedic Surgeons Are Less Prepared. Accident Fund Insurance Company/Comp West - Celebrates 100 Year Anniversary. DWC Opens Registration for its 20th Annual Educational Conference.

Health care fraud perpetrators cost the Federal government and American tax payers billions of dollars each year. The Centers for Medicare & Medicaid Services is now working with the Office of the Inspector General, the United States Attorney office and the Federal Bureau of Investigation to eliminate such fraudulent activity. This initiative is creating additional burdens on home health care companies, and therefore, they must be aware and prepared to handle the additional scrutiny. Home health care agencies must be aware of the changes in the industry. And there are certain actions they should take to protect themselves. Without a firm understanding of the behavior that is prohibited, there could be severe adverse consequences.