Delena Howard,
CPC, CPC-H

Executive Director

 

To learn more on how we can help your business please call (904) 224-9787 or email Delena.

 

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Healthcare Fraud Services

 

LBA Healthcare Consulting Services is proud of its accomplishments in fighting healthcare fraud.

 

Healthcare fraud is the intentional deception or misrepresentation of healthcare transactions by a provider, employer group or beneficiary for the purpose of receiving an unauthorized benefit or financial gain. Individuals convicted of this crime face substantial fines and, in some cases, imprisonment.

 

Currently, healthcare fraud costs Americans an estimated $100 billion per year. New Office of Inspector (OIG) guidelines and recent changes to the U.S. sentencing guidelines raise the bar for compliance programs.

 

LBA Healthcare Consulting Service’s Special Investigations Unit (SIU) examines possible incidents of fraud. The SIU receives complaints (or leads) from a number of sources including providers, attorneys, employers, beneficiaries, law enforcement and government officials and other healthcare companies. After receiving a report of possible fraud, the SIU investigates the allegation and works with the appropriate agencies or groups to resolve the issue.

Our Healthcare Compliance Services Include:

• Physician educational audits, including EM guidelines, medical necessity rules, incident to, and consulting
• Benchmarking against national guidelines
• Medicare compliance plan program, including development and implementation
• Federal inspection preparedness

Our Healthcare Audit Services Include:

• Survival of a medicare audit
• Expertise on coding issues
• Federal program negotiations with regards to audit issues
• Internal control procedures, including assessment, development and implementation