Strengthening Healthcare: ??Podiatry Fraud Insights from Eric Rubenstein

At Advize , we prioritize maintaining the highest standards of healthcare compliance and integrity. Today, we delve into #podiatry insights shared by our SME and Retired Senior Special Agent HHS-OIG, Eric Rubenstein, MSCJ, CFE .

Eric Rubenstein, MSCJ, CFE draws from his extensive experience to emphasize the severe consequences of healthcare fraud. He asserts, "The provider community that is bent on committing fraud will not care one bit about what those in the FWA world have to say about proactive and positive industry compliance." This underscores the urgent need for proactive measures, especially within specialties like podiatry that face heightened scrutiny.

Recent events vividly illustrate these concerns. A Tennessee podiatrist this past week received a four-year prison sentence for orchestrating a $4 million fraud scheme, exploiting Medicare and TennCare with medically unnecessary foot bath medications. This highlights the critical importance of stringent compliance frameworks.

Key Insights from Eric:

• Heightened Scrutiny in Specialties: Podiatry and similar specialties undergo intense scrutiny due to their susceptibility to fraudulent practices. Eric's expertise underscores the necessity for vigilance and strict adherence to regulatory standards.
• Identifying Red Flags: Eric shares the importance of recognizing warning signs, such as the misuse of medications not intended for foot baths. He vividly illustrates this by saying, "Imagine going to your grandmother's house for Sunday sauce, and all the ingredients were just floating on top of the tomato paste. This is what these foot baths are like. If the medications aren’t water soluble, they won’t work," illustrating the disregard for medical standards and patient care.
• Building Effective Compliance Plans: At Advize , we can develop robust compliance strategies tailored to mitigate specific risks within our operations. By implementing proactive measures, we can significantly reduce vulnerabilities to fraud.

Our Recommendations:

• Watch our Webinar: Explore Eric's in-depth discussion on this topic with Dr. Gary Cicio, DABFAS, CPC.
• Educational Initiatives: Conduct regular training sessions to educate healthcare providers on appropriate medication usage and billing practices, emphasizing ethical standards and the consequences of non-compliance.
• Comprehensive Audits: Implement frequent audits to monitor adherence to compliance protocols and promptly identify any irregularities or potential fraud indicators. These audits should be thorough and targeted, covering critical areas vulnerable to fraud.
• Collaboration and Advocacy: Advocate for reforms across the healthcare industry, collaborating closely with regulatory bodies to enhance transparency and accountability. Engage in proactive dialogue to influence policy changes that strengthen fraud prevention measures.

The stakes are high, and the need for compliance measures is more apparent than ever. We are committed to leading by example in ethical healthcare practices. By implementing Eric's recommendations—enhancing education, conducting thorough audits, and advocating for industry-wide reforms—we can fortify our defenses against fraud and uphold the highest standards of integrity.

[??Read Eric's post on this topic here!]