Healthcare Fraud Expert Witness

Wed, 15 Jun 2005 08:54:25 -0700

The first Medicaid director I worked for always said, “Anecdotes trump data, but data plus anecdotes will win every time.” When you go to trail, you need the data and the anecdotes to support your position.

Anecdotes trump data, but data plus anecdotes will win every time.

If you’re prosecuting a healthcare fraud criminal case, you must show that there was intent to defraud. The defendant will probably claim that he or she just made an honest mistake, so you need to be able to show a consistent pattern of abuse. You need to show that the defendant’s practices were very different from his peers. You may be able to use a map that shows that it was impossible for a provider to have been to all of the places he billed for on single day. You want to identify victims of the fraud, who can testify how they were harmed.

When you’re defending a healthcare fraud case, you want to show that your client was doing what he thought was right. You want to demonstrate that the billing guidelines were not clear, which caused him to make the same mistake many other people make. You want to show that your client’s activities look like his peers, if his peers are identified correctly (for example, you wouldn’t want to compare a pediatric dentist to a general practice dentist). You want to be able to find the weaknesses in the prosecution’s case.

Keynote Speaking and Workshops

Tue, 1 Jun 2004 07:53:09 -0700

Successful fraud control never results from a set of algorithmsit depends upon shifting organizational culture. Our workshops help participants understand the incentives that drive fraud, so they can take a proactive role in fighting fraud.

We’ll prepare custom workshops to meet your needs. Just contact us by phone or email.

Mathias Consulting - Services

Healthcare Fraud Expert Witness

Keynote Speaking and Workshops