The F Files

Too-good-to-be-true promises often hide the biggest fraud schemes. In this episode, Mandi and Daphne explore the “pot of gold” illusion in fraud, from leprechaun folklore to the real-world deception behind the Theranos scandal. The episode also features a conversation with HCFS team member Paula about HCFSElevate, the upcoming user conference in Austin, where guest speaker and whistleblower Tyler Schultz will share the story behind exposing Theranos and why investigative professionals remain essential to uncovering fraud.

From bloodletting and Botox to ghost doctors and falsified lab codes, this episode exposes the dark side of "wellness" clinics and concierge med spas. Join hosts Daphne Krout and Mandi Cook as they uncover firsthand accounts of risky procedures, insurance manipulation, and outright fraud. Featuring a special guest RN turned fraud fighter who shares what really happened behind closed doors.

Non-emergency transport might sound routine, but it's become a hotspot for fraud. In this episode of The F Files, hosts Daphne and Mandi dig into schemes involving falsified mileage, upcoded services, and even transport crews lacking certification. From bizarre van rides to six-figure fraud cases, they reveal how something as simple as a ride to dialysis can turn into a $6 million scam. Whether you're in SIU, compliance, or analytics, get ready to uncover red flags and sharpen your detection game.

Phantom providers haunt healthcare systems — billing for services never rendered, using identities that don’t exist. In this episode, hosts Daphne Krout and Mandi Cook pull back the sheet on these ghostly schemes and reveal how SIUs and analytics teams can expose the fraud behind the facade.

In this special handoff episode, EVP Karen Weintraub passes the torch to our new hosts and shares what’s ahead for the Healthcare Fraud Shield podcast - including a new identity!

Season 4 will be a series of interviews with members of our own Special Investigations Unit.  We will showcase different members of our team including the director, investigators, coders and clinicians who will join each episode for a fun reflective chat on their first case/various experiences and lessons learned.  In this episode, Kelli Hess who has vast experience investigating both Medicare and Commercial plan data will walk through her background in the FWA industry and one of her first experiences. If you would like more information, contact us at [email protected]

Season 4 will be a series of interviews with members of our own Special Investigations Unit.  We will showcase different members of our team including the director, investigators, coders and clinicians who will join each episode for a fun reflective chat on their first case/various experiences and lessons learned.  In this episode, Maria Seedorff who has a wealth of information will walk through her background in the FWA industry and one of her first experiences. Maria is a chiropractor, a Certified Professional Coder, and Accredited Health Care Fraud Investigator and one of our FWA gurus.

Season 4 will be a series of interviews with members of our own Special Investigations Unit.  We will showcase different members of our team including the director, investigators, coders and clinicians who will join each episode for a fun reflective chat on their first case/various experiences and lessons learned.  In this episode, our Director of Special Investigations, Ken Cole will walk through his background in the FWA industry and one of his first experiences investigating cases using Healthcare Fraud Shield's platform.

Season 4 will be a series of interviews with members of our own Special Investigations Unit.  A different member of our team of investigators, coders and clinicians will join each episode for a fun reflective chat on their first case and lessons learned.  In this first episode, our EVP Karen Weintraub will walk through her experience in her first case that contained all the key elements from data mining, onsite audits, medical record retrieval and reviews, interviews, working with attorneys, settlement, negotiation and more....

Welcome to Season 3, Episode 4 of the Healthcare Fraud Shield podcast. In this episode Karen Weintraub (along with an appearance from her mighty blue macaws) will discuss our Shared Analytics initiative across clients used to detect emerging schemes, and trends for potential fraud, waste and abuse.    If you would like to record a message for our podcast you can go to https://anchor.fm/hcfs/message. If you want to learn more about Healthcare Fraud Shield's integrated FWA software solution, check out our website at www.hcfraudshield.com.    Do you have any questions or podcast topic ideas or need assistance registering for our webinars?  Email us at [email protected].

Welcome to Season 3, Episode 2 of the Healthcare Fraud Shield podcast. In this episode Karen Weintraub will discuss travelling physicians and potential for fraud, waste and abuse.    If you would like to record a message for our podcast you can go to https://anchor.fm/hcfs/message. If you want to learn more about Healthcare Fraud Shield's integrated FWA software solution, check out our website at www.hcfraudshield.com. If you would like to sign up for our webinars you can monitor our future webinars here: REGISTER HERE.    Do you have any questions or podcast topic ideas or need assistance registering for our webinars?  Email us at [email protected].

Welcome to Season 3, Episode 2 of the Healthcare Fraud Shield podcast. In this episode Karen Weintraub will describe Acetaminophen Toxicity and how FWA analytics companies such as Healthcare Fraud Shield can detect potentially harmful doses being prescribed.    If you would like to record a message for our podcast you can go to https://anchor.fm/hcfs/message. If you want to learn more about Healthcare Fraud Shield's integrated FWA software solution, check out our website at www.hcfraudshield.com. If you would like to sign up for our webinars you can monitor our future webinars here: www.tinyurl.com/hcfswebinar.    Do you have any questions or podcast topic ideas or need assistance registering for our webinars?  Email us at [email protected].

Welcome to Season 3, Episode 1 of the Healthcare Fraud Shield podcast. In this episode Karen Weintraub (along with some cameos from her dogs) will walk through a few new things happening in 2022 and spending a little time focusing on things other than procedure codes (modifiers, places of service, and diagnosis codes).    If you would like to record a message for our podcast you can go to https://anchor.fm/hcfs/message. If you want to learn more about Healthcare Fraud Shield's integrated FWA software solution, check out our website at www.hcfraudshield.com. If you would like to sign up for our webinars you can monitor our future webinars here: www.tinyurl.com/hcfswebinar.    Do you have any questions or podcast topic ideas or need assistance registering for our webinars?  Email us at [email protected].

Welcome to Season 2, Episode 7 of the Healthcare Fraud Shield podcast. In this episode we talk to Eric Rubenstein a retired OIG Agent who currently the Director of Litigation/FWA Support at Advize Health.  If you would like to record a message for our podcast you can go to https://anchor.fm/hcfs/message. If you want to learn more about Healthcare Fraud Shield's integrated FWA software solution, check out our website at www.hcfraudshield.com. If you would like to sign up for our webinars you can monitor our future webinars here: www.tinyurl.com/hcfswebinar.    Do you have any questions or podcast topic ideas?  Email us at [email protected].

Welcome to Season 2, Episode 6 of the Healthcare Fraud Shield podcast. In this episode we reflect on COVID-19 FWA and discuss what we thought vs. what actually happened as it pertains to FWA.  If you would like to record a message for our podcast you can go to https://anchor.fm/hcfs/message. If you want to learn more about Healthcare Fraud Shield's integrated FWA software solution, check out our website at www.hcfraudshield.com. If you would like to sign up for our webinars you can monitor our future webinars here: www.tinyurl.com/hcfswebinar.    Do you have any questions or podcast topic ideas?  Email us at [email protected].

Welcome to Season 2, Episode 5 of the Healthcare Fraud Shield podcast. In this episode we have a special guest, Toni Elhoms from Alpha Coding Experts who will discuss pain management coding and schemes.  If you would like to record a message for our podcast you can go to https://anchor.fm/hcfs/message. If you want to learn more about Healthcare Fraud Shield's integrated FWA software solution, check out our website at www.hcfraudshield.com. If you would like to sign up for our webinars you can monitor our future webinars here: www.tinyurl.com/hcfswebinar.    Do you have any questions or podcast topic ideas?  Email us at [email protected].

Welcome to Season 2, Episode 4 of the Healthcare Fraud Shield podcast. In this episode we will discuss Diagnosis Related Groups (DRGs).  If you would like to record a message for our podcast you can go to https://anchor.fm/hcfs/message. If you want to learn more about Healthcare Fraud Shield's integrated FWA software solution, check out our website at www.hcfraudshield.com. If you would like to sign up for our webinars you can monitor our future webinars here: www.tinyurl.com/hcfswebinar.    Do you have any questions or podcast topic ideas?  Email us at [email protected].

Welcome to Season 2, Episode 3 of the Healthcare Fraud Shield podcast. In this episode we will discuss AI and the Challenges for Fraud, Waste and Abuse Detection.  If you would like to record a message for our podcast you can go to https://anchor.fm/hcfs/message. If you want to learn more about Healthcare Fraud Shield's integrated FWA software solution, check out our website at www.hcfraudshield.com. If you would like to sign up for our webinars you can monitor our future webinars here: www.tinyurl.com/hcfswebinar.    Do you have any questions or podcast topic ideas?  Email us at [email protected].

Welcome to Season 2, Episode 2 of the Healthcare Fraud Shield podcast. In this episode we will address the who, what, where, when and why of Prepayment. If you would like to record a message for our podcast you can go to https://anchor.fm/hcfs/message. If you want to learn more about Healthcare Fraud Shield's integrated FWA software solution, check out our website at www.hcfraudshield.com. If you would like to sign up for our webinars you can monitor our future webinars here: www.tinyurl.com/hcfswebinar.    Do you have any questions or podcast topic ideas?  Email me at [email protected].

This is the first episode of Season 2 and we look forward to providing exciting content in 2021.  In this episode we will review some of the new HCPCS codes for 2021.    If you would like to record a message for our podcast you can go to https://anchor.fm/hcfs/message.   If you want to learn more about Healthcare Fraud Shield's integrated FWA software solution, check out our website at www.hcfraudshield.com.  If you would like to sign up for our webinar in January, go to www.tinyurl.com/hcfswebinar.    Do you have any questions or podcast topic ideas?  Email me at [email protected].

This episode is about the questions you want to ask yourself when evaluating a FWA Vendor.   This is the last episode of Season 1, but we look forward to providing more content in 2021.   If you would like to record a message for our podcast you can go to https://anchor.fm/hcfs/message.   If you want to learn more about Healthcare Fraud Shield's integrated FWA software solution, check out our website at www.hcfraudshield.com. If you have any questions or would like to request a podcast on a specific topic, email [email protected].

This episode is about searching smarter throughout your audits and investigations.  We discuss incorporating research tools and techniques to assist in the identification of information relevant to fraud, waste and abuse.  If you want to learn more about Healthcare Fraud Shield's integrated FWA software solution, check out our website at www.hcfraudshield.com. If you have any questions or would like to request a podcast on a specific topic, email [email protected].

This episode is a continuation of a series on the good, the bad and the ugly of investigations.  In part 3 of this series we will focus on medical overpayments and recoveries, but stay tuned for future podcasts in this series.    If you want to learn more about Healthcare Fraud Shield's integrated FWA software solution, check out our website at www.hcfraudshield.com. If you have any questions or would like to request a podcast on a specific topic, email [email protected].

This episode is a continuation of a series on the good, the bad and the ugly of investigations.  In part 2 of this series we will focus on medical records, but stay tuned for future podcasts in this series on requesting refunds, negotiating and referrals.    If you want to learn more about Healthcare Fraud Shield's integrated FWA software solution, check out our website at www.hcfraudshield.com. If you have any questions or would like to request a podcast on a specific topic, email [email protected].

This episode is the start of a series on the good, the bad and the ugly of investigations.  In part 1 of this series we will focus on data mining, but stay tuned for future podcasts in this series on medical records/gathering evidence, requesting refunds and negotiating and referrals.    If you want to learn more about Healthcare Fraud Shield's solution, check out our website at www.hcfraudshield.com.

Healthcare fraud investigators are tasked with gathering information and evidence used to disprove or prove an allegation of potential fraud, waste or abuse.  In this episode, we discuss some of our experiences with conducting onsite audits as well as tips and tricks.  Thanks for listening!

This episode is an introduction to Healthcare Fraud Shield.  Learn a little about our company, what makes Healthcare Fraud Shield different and why is healthcare fraud so complicated?  Thanks for listening!  For more information, email us at [email protected].

In the vast maze of medical billing, most claims follow the rules. Most codes match the care. But every so often… a claim strays from the pattern. A service that never happened. A modifier that whispers a lie. The data twitches. The story doesn’t add up. And that’s when we go looking. Because when claims get weird… we get to work.