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Latest Headlines

Supreme Court decision expands False Claims Act liability for providers

The recent  Kellogg Brown & Root Servs., Inc. v. United States ex rel. Carter  Supreme Court decision is a very glass half-full/half-empty ruling for healthcare providers. This could lead to an increase in False Claims Act cases in the future, healthcare attorney George Breen said in an exclusive interview with  FierceHealthPayer: AntiFraud.

Hospitals, ambulance companies share fraud liability burden

Although there has been a rash of ambulance fraud activity over the last several months, that has been an area of concern at the federal level for several years, Sean McKenna, a partner at Haynes and Boon LLP, said in an exclusive interview with  FierceHealthPayer: AntiFraud.

Using link analysis to untangle fraud webs

Link analysis has become an important technique for discovering hidden relationships involved in healthcare fraud.  FierceHealthPayer:AntiFraud  recently spoke to Vincent Boyd Bryant about the value of this tool for payer special investigations units.  

What payers should know about chiropractic fraud, waste and abuse

FierceHealthPayer: Anti-Fraud spoke to Daniel S. Bowerman, D.C. to learn about chiropractic fraud and overutilization. Dr. Bowerman has been a practicing chiropractor since 1978. He's a principal at Expert Opinions Consulting in Philadelphia, and he served as a health plan medical director for 13 years.

How to perform well in adversarial proceedings

Anti-fraud professionals may need to testify at depositions, licensure hearings or occasional criminal trials, and this can be a stressful part of the job. For advice on performance improvement, FierceHealthPayer:Anti-Fraud spoke to Nabil Istafanous, J.D.

What payers need to know about the False Claims Act

FierceHealthPayer:Anti-Fraud spoke to Sean McKenna, J.D., to learn how the False Claims Act--a federal law dating back to the Lincoln administration--helps combat healthcare fraud.

More fraud investigation tips from Deloitte's Mike Little

FierceHealthPayer: Anti-Fraud talked to Deloitte's Michael E. Little for expert advice on how special investigations units can improve their anti-fraud casework. Little shares additional fraught fighting insights in this final segment of a two-part interview. 

Fraud investigation tips from Deloitte's Mike Little

FierceHealthPayer: Anti-Fraud talked to Michael E. Little for expert advice on how special investigations units can improve their anti-fraud casework. Little is a senior manager in the forensic practice of Deloitte Financial Advisory Services, LLP in Philadelphia.

Dealing with records destruction in fraud investigations

A New Jersey chiropractor destroyed evidence sought by authorities investigating her billings for potential fraud, the FBI announced  last week. For a federal law enforcement perspective on how to manage these types of setbacks, FierceHealthPayer: Anti-Fraud spoke to Ted Radway, an assistant United States attorney for the District of Columbia.

WellPoint's Patrick McIntyre on anti-fraud analytics partnerships

FierceHealthPayer: Anti-Fraud spoke to Patrick McIntyre for expert advice on smart shopping for anti-fraud data analytics and how to work well with vendors. McIntyre is senior vice president of healthcare analytics at Wellpoint.