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Medicaid Fraud Losses Exceed Recovery by Millions in North Carolina

Medicaid fraud is at a crisis level of losses that exceed recovery in North Carolina. The Final Report to the Joint legislative Program Evaluation Oversight Committee, Report Number 2016-10 dated November 14, 2016, entitled: “Medicaid Program Integrity Section is Not Cost-Effectively Identifying and Preventing Fraud, Waste, and Abuse, reveals that costs to discover fraudulent claims…

HHS and OIG Release Fiscal Year 2017 Work Plan – Highlights

The U.S. Department of Health and Human Services (HHS), Office of Inspector General (OIG), fiscal year 2017 Work Plan gives an overview of new initiatives and activities as well as reports on ongoing programs. According to a HMENEWS, the recently released work plan includes the OIG’s plans to review, “the process CMS used to conduct…

Medicare Fraud Strike Force Successful with “Big Data” Detection Methods.

In a story reported by The Fiscal Times, U.S. customs officials arrested a woman at the Dallas-Fort Worth International Airport mid October, 2016, who is suspected of involvement in one of the biggest Medicare fraud schemes in history. This bust is another record-breaking fraud scheme that found its end as part of the Obama administration’s crackdown on Medicare…

New York Doctor Convicted of Multimillion-Dollar Health Care Fraud

A New York surgeon who practiced at hospitals in Brooklyn and Long Island, New York, was convicted last night for submitting millions of dollars in false and fraudulent claims to Medicare. Assistant Attorney General Leslie R. Caldwell of the Justice Department’s Criminal Division, U.S. Attorney Robert L. Capers of the Eastern District of New York,…

The Power of Work Teams

Part 5 of 6 – Tips from Craig’s Verification Tips on Staffing for The Art and Science of Verifications Distributed Leadership Provides Mentoring and Motivation If your verification department has more than 10 people, you should consider using work teams of 5 to 6 people each for these reasons: 1. Competition between teams makes the…

Measure a Trainee’s Progress

Part 4 of 6 – Tips from Craig’s Verification Tips on Staffing for The Art and Science of Verifications. As a sailor, knowing my position on a chart tells me where I am on the vast ocean. Being a trainee in a new job is similar: am I where I am supposed to be and…

Training your Verification Staff

Part 3 of 6 – Tips from Craig’s Verification Tips on Staffing for The Art and Science of Verifications. After talking with many CRAs over the years, I have found that training new verification staff often falls to the most senior verification staff and consists of “showing them the ropes.” This is not scalable and…

National Health Care Fraud Takedown Results in Charges against 301 Individuals for Approximately $900 Million in False Billing

Most Defendants Charged and Largest Alleged Loss Amount in Strike Force History Attorney General Loretta E. Lynch and Department of Health and Human Services (HHS) Secretary Sylvia Mathews Burwell announced today an unprecedented nationwide sweep led by the Medicare Fraud Strike Force in 36 federal districts, resulting in criminal and civil charges against 301 individuals,…

Qualifying and Training Staff Makes your Verification Department Effective

Part 2 of 6 – Tips from Craig’s Verification Tips on Staffing for The Art and Science of Verifications. Not every candidate has the attributes of a verifier. Understanding the traits of top performers will provide a framework for qualifying individuals as you build your verification team. Here, the wisdom is, a little research goes…

Chad Fritz Joins Verisys as Chief Technology Officer

Verisys Corporation, a data and technology company specializing in health care data aggregation and verifications is pleased to announce the appointment of Chad Fritz as the Chief Technology Officer. During his 18 year career, Mr. Fritz has solved a variety of challenging business problems through the creative use of new technology. His leadership, clarity and…