Healthcare Fraud War

By Tom Rhudy

7 keys to winning the Healthcare Fraud War, written by an attorney/healthcare provider, specializing in the investigation of healthcare fraud and abuse.

• Language: English
• Publisher: Tom Rhudy
• Release date: Mar 13, 2020
• ISBN: 9781393588894

Book preview

TABLE OF CONTENTS

Foreword ..................................................................................................................3

Acknowledgments ..................................................................................................... 5

Introduction ..............................................................................................................9

Chapter 1: Isn't The Term Health Care Fraud War Extreme? ........................................ 12

Chapter 2: Insurance Carriers - Good Hands? I Think Not! .......................................... 19

Chapter 3: It ain't what they don't know that concerns me ......................................... 29

Chapter 4: Trade Associations May Be Dangerous To Your Health .................................... 36

Chapter 5: It's Time To Wake Up And Take Our Heads Out Of The Sand! .......................... 43

Chapter 6: [T]o kill the enemy, . . . men must be roused to anger .................................. 52

Chapter 7: Why Are Providers Always On The Hit-List? .................................................. 61

Chapter 8: The wisest and most knowledgeable human being ........................................ 72

Chapter 9: Do Health Care Consumers (Patients) Matter? .............................................. 79

Chapter 10: It Never Troubles A Wolf How Many The Sheep Be. ...................................... 88

Foreword

This is a book that had to be written, and this is the perfect time to publish this much-needed information. As the author of three books, publisher of more than 100 articles, expert witness in more than 100 lawsuits, former professor, and consultant on both television and radio, Dr. Rhudy is the perfect author for this information.

As I write this, the Presidential campaign is underway in the United States. Of course, healthcare is likely to be the most contentious area of discussion. Americans are on the cusp of choosing leaders who will be critical in policy-making decisions that will affect, among many other things, the direction in which the delivery of healthcare will take place within its borders. Unless drastic changes are made, the policies currently scheduled to be implemented will result in a situation in which healthcare costs will absorb 20% of the nation's economy.

The path taken in the next year will be monumental. It is not just the future of health care in America that is in question;  will also be impacted.

In this book, Dr. Rhudy has provided an invaluable tool for properly analyzing and developing strategic methods by which readers may become actively engaged, and actually work toward, achieving victory in the health care fraud and abuse war currently being waged against Americans. He doesn't simply debunk commonly-accepted notions. Rather, he relies on his unique perspective to provide spectrum of issues that adversely affect the delivery of healthcare to millions of . Dr. Rhudy makes it clear that citizens must earnestly address the misperceptions that surround this topic, and discusses ways in which Americans may obtain a much greater benefit from the dollars being spent.

This book goes beyond decrying the current situation. It actually identifies seven keys to strategically attack and prevail in the battle against health care fraud and abuse. It takes a candid look at ways in which precious resources are currently being wasted and discusses logical ways in which these trends may be reversed.

Obviously, no system is either perfect or totally balanced. However, Dr. Rhudy exposes the rhetoric in which legislators, law enforcement, and representatives from the insurance industry frequently engage. He thoroughly evaluates the methodology behind current efforts and the inherent limitations that stem from them.  He also exposes the abysmal record of current tactics and the false notion that Americans are currently winning the war.

Fortunately, this is also a fix-it book. It discusses specific ways in which resources may be combined to achieve the success about which politicians can only dream. These seven keys will actually open the door to commonsense solutions that all Americans can understand and apply.

If you're generally interested in getting to the core of the health care fraud and abuse problem, this is the perfect book. Dr. Rhudy's decades of experience in healthcare, law, and investigation of health care fraud and abuse make him extremely well-qualified to be its author. Intriguingly, the keys required to achieve this victory do not increase current expenditures by even one penny!

If you're one of those individuals who intuitively realizes that something must be done, but isn't  – even though you frequently hear a great deal about health care fraud and abuse and the cost to the economy – then prepare to join the battle with Dr. Rhudy.

RAYMOND AARON

City, Date

Acknowledgments

I would like to take this opportunity to thank those individuals who have patiently worked with me over the years to develop skills and knowledge regarding investigations into health care fraud and abuse. The number is vast.

I would particularly like to take this opportunity to thank Daniel Osborne, former National Insurance Crime Dan approached me more than 20 years ago, we have had the opportunity to work on numerous cases together and have since become friends.

I'd also like to thank the many members of the FBI who have patiently listened to the concerns the assistance and training necessary to address this issue, and also gave us access to a forum which we  used to provide training to other law enforcement agents throughout the country.

I'd also like to thank William Wallace (no, not that one), former

My wife, Marie, has been extremely patient with me over the years. Individuals who are not familiar with these investigations are unaware of the personal toll that such investigations -sued man in America." Little did I know that a future lawsuit – even though I prevailed - would ultimately cost me more than a million dollars. After that, the comment seemed humorous.

I've been blessed to have an opportunity to teach thousands of physicians, surgeons, chiropractors, insurance adjusters et al. When this journey originally began, victory can only be achieved if all of these forces and work in a cooperative and cohesive manner

There are also numerous legislators for whom I have tremendous respect and admiration. One  Senator John Carona (Tx), was not only willing to review and endorse some of our efforts in developing programs to help stem the tide on health care fraud and abuse, but he also suggested that they be held up as models for the state of Texas.

Chuck Duvall was an vidualNational HealthFraud Conference in Kansas City, where he and his father were presenting topics related to fraud in the chiropractic profession. I have found Chuck to be a man of integrity and commitment, and greatly value both his friendship and tutelage.

Chuck, a resident of Ohio, flew to Kansas City to testify on my behalf in a trial where I was being sued for a million dollars by a woman who had been sent to me by an insurance carrier the course of my examination. Chuck's testimony assisted in garnering a unanimous verdict in my favor. (Additionally, the jurors were skeptical of the plaintiff's truthfulness when they discovered that her chiropractor, Frank Ferguson, had scheduled this woman to return to his office immediately following my exam.)

I also greatly appreciate the individuals who have assisted in various ways. Certainly, without Robert M. Smith's financial assistance, the compliance program that will serve as the basis for one of the recommendations made in this book would have never developed. In addition to financial assistance, he also provided a tremendous amount of administrative assistance and invaluable resources.

I also owe a tremendous amount of gratitude to Dr. Saucedo, and all of the doctors at Accident & Injury. These doctors were willing to undergo a tremendous amount of trial-and-error as we forged ahead in this process. Undoubtedly, this crucible became extremely turbulent at times for all involved.

Dr. Christy was another individual who was willing to endure the slings and arrows (along with the rest of the doctors at Accident & Injury) in an effort to combat this issue. She possesses a tremendous amount of courage and wisdom and should be lauded for the devotion that she expended in this effort.

There are two other individuals to whom I owe a great deal of appreciation. Unfortunately, both

The first CEO of the Consumer Health Information Research Institute (CHIRI). Dr. Renner , and I was privileged to be the first chiropractor he allowed to work directly with him at CHIRI.

In this capacity, I had an opportunity to field questions from people