Posts by Tony Stonem
Forest Park TX kickback scheme totaling over 40 million dollars
Kickbacks are still not allowed, much to the surprise of a Forest Park TX medical group. This story coming from Dallas News‘ federal courts reporter Kevin Krause. The Forest Park Medical Center federal bribery and kickback trial in Dallas resulted in landmark convictions against the hospital’s managers and doctors. It also exposed Texas’ longstanding failure…Read More
2018 was a banner year for HIPAA compliance issues
At patient options we always want to keep you up to date with what is happening in our world of compliance. Lets look at the 2018 report of major trends. After a relatively slow first six months, 2018 turned into an active year for HIPAA enforcement, with the Department of Health and Human Services’ (HHS)…Read More
AI is coming to detect healthcare fraud
Forbes’ insights brings us this article about the future of healthcare fraud detection, How AI Can Battle A Beast—Medical Insurance Fraud. This is a future of fraud detection that is inevitable. With the rise of the amount healthcare data it is almost a forgone conclusion that computers are going to be integrated into battling healthcare…Read More
Even the big dogs are getting caught up in fraud.
Coming to us via NBC26 we see reports of Walgreens settling a huge case of fraud in the state of Wisconsin. Even the large corporations can have what we hope are oversights in their plans so your compliance is essential to keeping your practice safe. The U.S. Attorney in the Eastern District of Wisconsin says…Read More
In 2018 the DOJ recovered 2.5 Billion dollars from Healthcare Fraud
Welcome to the new year. Lets begin by looking back. The DOJ has just released it’s final total funds recovered figure for 2018… It is 2.5B dollars. Lets take a look right from the horse’s mouth on the justice.gov website. Keep in mind that this is just federal dollars that we are talking about here…Read More
AI in healthcare fraud detection is here! Protect yourself with Patient Options!
It is here folks! Machine learning and AI are going to be used in a proactive way to detect the fraud in the healthcare market. The investigators will be well down the trail of knowing who to audit before they even send the letter they will have a pretty strong idea of what they will…Read More
What the claim investigation market is doing
A quick way to see what we are going to deal with as providers down the road is to look into what the healthcare fraud industry’s latest advances. Insight partners has released a report on the future of the fraud detection industry in their report, “Healthcare Fraud Detection Market Size and Key Trends in terms…Read More
The most basic case of fraud.
Healthcare fraud happens all the time but the most classic case of fraud is charging for something and not performing the service. Let’s look at the at the recent arraignment of Primera healthcare executives in Atlanta Georgia. Tim Darnell from the ATL based paper patch writes in his article, “Primera Medical Group Execs Charged With…Read More
Serious Fraudulent billing in Texas. Don’t do this.
As a physician you have taken an oath to serve your patients to the best of your ability. In the environment of healthcare it is very easy to commit fraud, whether it be intentional or unintentional, it happens. One way to make sure that you land on the radar for an audit is to just…Read More
Healthcare rumblings with Stark law and how it can impact you.
Let’s delve into Stark law and how it impacts the delivery of healthcare. Stark Law is a set of United States federal laws that prohibit physician self-referral, specifically a referral by a physician of a Medicare or Medicaid patient to an entity providing designated health services (“DHS”) if the physician (or an immediate family member) has a financial relationship with that entity. This weeks article…Read More