Episode 3 - The Good, the Bad, and the Ugly of Investigations: Part 1 - Data Mining

Karen Weintraub joins Sean to discuss Special Investigative Units, the state of healthcare, fraud and the what the future holds. It is so critical to understand that not all who work on the payor side are "Out to get you" and that in a lot of cases healthcare professionals like Karen are trying to refute allegations of misconduct. Take a listen and we are sure you're going to agree, this was a fascinating interview with a fascinating healthcare professional! About Karen: Karen Weintraub is the Executive Vice President SIU for Healthcare Fraud Shield. As EVP, Ms. Weintraub is responsible for the design and development of the company's healthcare fraud detection software products and services. She provides subject matter expertise on system design and workflow, business rule development, data mining and fraud outlier algorithms as well as SIU policies and procedures. Prior to joining Healthcare Fraud Shield, Ms. Weintraub was the Senior Manager of SIU Services at GDIT and the Supervisor of Investigations for Health Net, Inc. and managed all northeast healthcare investigations for all commercial, Medicaid and Medicare business and claims of fraudulent activity. Thank you for helping to make The Compliance Guy a 2022 Top 25 Podcast: https://blog.feedspot.com/regulatory_compliance_podcasts/

In this episode of Medical Matters Podcast, Dr. Peter Brier and Nurse Practitioner Kelly McCormack discuss the issue of healthcare fraud, and its affects on the system. Also, an update on mask mandate.

This week, Executive Vice President John Byrne, and Creative Director Elliot Berman of the AML RightSource staff talk about FinCEN Advisory FIN 2021-A001 which focuses on health insurance and healthcare fraud. John and Elliot discuss the red flags in the Advisory and actions FIs can take to identify this activity and messages they can share with their customers to help them recognize these schemes.

Jeb White, who was our host for the past 3 years has left our non-profit to start up an organization to help level the playing field in college admissions. You can learn more at collegeadmissions.com.To learn more about The Anti-Fraud Coalition, click here.------------------Fraud in America is made possible by the generous donation of Getnick Law, a boutique Manhattan law firm dedicated to fighting fraud and promoting business integrity.------------------Fraud in America Social Links🌐 Website🐦 Twitter🎥 YouTube👔 LinkedIn------------------To learn more about Fraud in America, visit taf.org/podcast.Thoughts? Guest suggestions? Email us at info@fraudinamerica.com."Fraud in America" is produced by Jacklyn DeMar and James King. Our website was designed by Wide Eye Creative. Our music was made by Spatial Relations. Our visual assets were designed by PPA Agency. Fraud in America is a project of The Anti-Fraud Coalition, a 501(c)(3) organization. You can learn more about it at taf.org