Healthcare

Preventing fraud and abuse continues to be a huge problem for the health care industry. Over $80 billion dollars is lost annually to health care fraud alone.  As a result, governmental agencies have implemented new regulations and placed increasing emphasis on investigating and prosecuting health care fraud.

ARA Fraud & Forensic Services is dedicated to working with medical practice groups,  hospital systems and assisted living / skilled nursing organizations to prevent and detect fraud and abuse. We believe in taking proactive measures to help our clients correct problems before the government becomes involved. Our investigative expertise combined with our regulatory knowledge allows us to help clients avoid civil fines, criminal and administrative penalties while creating a fraud free environment.

Services offered:

• Assist with hiring ethical employees
• Deliver training to instill a fraud free culture
• Perform comprehensive fraud risk assessments which assess internal controls and areas of weakness to detect and prevent fraud
• Audit medical billing records
• Assess IT controls to safeguard PHI and HIPAA information for compliance
• Conduct internal investigations into various fraud schemes including medicare fraud, billing fraud, kick back schemes and expense reimbursement, to name a few.

2014 Fraud Statistics in Healthcare:

• The median fraud loss in medical practices is $200,000
• 83% of medical practices experienced losses as a result of fraud
• The average fraud lasts over 18 months before being detected
• The top three healthcare fraud schemes include billing, corruption and expense reimbursement

• Statute: 31 U.S.C. §§ 3729–3733

The Physician Self-Referral Law

• Statute: 42 U.S.C. § 1395nn

• Regulations: 42 C.F.R. §§ 411.350–.389

Criminal Health Care Fraud Statute

• Statute: 18 U.S.C. §§ 1347, 1349

For more information, please contact us at 636-346-9273 or email info@arastl.com