Question.1133 - Complete the findings part of the Fraud examination as required in the template provided in the course.
Answer Below:
FRAUD xxxxxxxxxxx REPORT xx Marie xxxxxxxx Instructor xx PAD xxx FROM xxxxxxxxx Encarnacion xxxxxxx of xxx -IG xx Nurse xxxxxxxxxxxx Charged xx Alleged xxxxxxx Health xxxx Fraud xxxxxx USAO-RI xxxxxxxxxx of xxxxxxx DATE xxxxxxxxxx Introduction xxxxxxxxxxxxx United xxxxxx Attorney's xxxxxx is xxxxxxxxxx the xxxxxxx District xx Rhode xxxxxx USAO-RI xxxxx is xxxxx closely xxxxxxxxx by xxx Department xx Justice xxx The xxxxxxx involve x nurse xxxxxxxxxxxx who xx accused xx dealing xx criminal xxxxxxx primarily xxxxxxxxxx false xxxxxx to xxxxxxx healthcare xxxxxxxx and xxxxxxxxx companies xxxx alleged xxxxxxxxxx behavior xx thought xx have xxxxxxxx in xxxxxxxxxxx financial xxxxxx within xxx healthcare xxxxxx which xxx negatively xxxxxxxx the xxxxxxx of xxxxxxxxxx services xxx patient xxxxxxxxxx This xxxxxxxx raises xxxxxxx issues xxxxxxxxx healthcare xxxxxxxxxxxx oversight xxx complexities xx billing xxxxxxx and xxx more xxxxxx issue xx healthcare xxxxx It xxxxxxxxxx how xxxxxxxx it xx for xxx enforcement xxx the xxxxxxxx system xx defend xxx integrity xx the xxxxxxxxxx sector xxxx also xxxxxxxxx the xxxxxxxxx necessity xxx monitoring xxx restrictions xx protect xxxxxx health xxx financial xxxxxxxxx IntroductionThe xx Attorney's xxxxxx in xxxxx Island xxxxxxx is xxxxxxxxxxxxx Nurse xxxxxxxxxxxx and xxx Department xx Justice xxx is xxxxxxx a xxxxxxx eye xx the xxxx This xxxxx exposes x significant xxxxx in xxx American xxxxxxxxxx system xxxx case xxxxxxx on xxxxxxxxxxx of xxxxx against x nurse xxxxxxxxxxxx who xx accused xx making xxxxxxxxx claims xx various xxxxxxxxxx programs xxx insurance xxxxxxxxx This xxxxxxxx activity's xxxxxx effect xxxxxxx to xxx healthcare xxxxxxxx causing xxxxxxxxxxx financial xxxxxx These xxxxxxxxx setbacks xxxxxxxx affect xxx quality xx healthcare xxxxxxxx and xxx overall xxxxxxx of xxxxxxxx This xxxx serves xx a xxxxx reminder xx the xxxxxxxxxxxxxxx present xx the xxxxxxxxxx profession xxxxx unethical xxxxxxxxxxx can xxxxxxxxxx It xxxx raises xxxxxxxx about xxx adequacy xx current xxxxxxxxx procedures xx will xxxxxxxxxxx the xxxxxxxxxxxx of xxxxxxxxxx billing xxxxxxxx explore xxxxxxx for xxxxxxxxx and xxxxxxxxxx fraudulent xxxxxx and xxxxxxxxxxx the xxxxx ramifications xxx healthcare xxxxxxxxx participating xx fraudulent xxxxxxx Additionally xxxxx assess xxx broader xxxxxxx on xxxxxx health xxx financial xxxxxxxxx within xxx healthcare xxxxxxxx underscoring xxx crucial xxxxxxxxxx of xxxxxx monitoring xxx regulatory xxxxxxxx to xxxxxx the xxxxxxxxx of xxxx essential xxxxxx in xxx society xxxxxxxxx Summary xxx a xxxxxx fraud xxxxxxxxxxx the xxxxxxxxx summary xxxxxx be xx more xxxx four xx five xxxxxxxxxx For x more xxxxxxx case xxx summary xxx reach x page xx length xxxx section xxxxxx summarize xxxx actions xxxx performed xxxxxx the xxxxx examination xxxx as xxxxxxxxx documents xxxxxxxxxxxx witnesses xxxxxxxxxx analyses xx tests xxx It xxxxxxxx the xxxxxx with xx overview xx what xxx did xxxxxx the xxxxxxxxxxx process xxxx section xxxxxx conclude xxxx a xxxxxxx of xxx outcome xx the xxxxxxxxxxx Scope xxx intended xxxxxxxx aims xx investigate xxx intricacies xx healthcare xxxxx within xxx United xxxxxx centering xx the xxxxxx case xx a xxxxx Practitioner xxxxxxx in x purported xxxxxxx health xxxx fraud xxxxxx The xxxxxxxx research xxxxxxxxx to xxxxx deeply xxxx the xxxxxxxxx issue xx healthcare xxxxx within xxx United xxxxxx by xxxxxxx examining x myriad xx authentic xxxx studies xxxxxxx on xxxxxxxxxxxxx the xxxxxxxxx repercussions xxxxxxxxxxxxx and xxxxxxxxxxx procedures xxxxxxxxxx with xxxxxxxxxx practices xxx study xxxx to xxxxxxxx the xxxxxxxxxx landscape xx healthcare xxxxx across xxxxxxx industries xxx comprehensive xxxxxxxxxxx will xxxxxxxxxx the xxxxxx effects xx these xxxxxxxxxx activities xx the xxxxxxxxxx system xxxxxxxx and xxx overall xxxxxxx while xxxxxxxxxxxx the xxxxx regulatory xxx preventive xxxxxxxx A xxxxxxx emphasis xxxx be xxxxxx on xxxxxxxxx how xxxxx fraudulent xxxxxxx influence xxx structural xxxxxxxxx of xxx nation's xxxxxxxxxx system xx achieve xxxx the xxxxxxxx will xxxxxxx an xxxxxxxxxx analysis xx multiple xxxxxxxxx healthcare xxxxx cases xxxxxxxxxxxx diverse xxxxxxxxxx activities xxxxxxx across xxxxxxxxx sectors xx the xxxxxxxxxx industry xx the xxxxxx States xx intends xx meticulously xxxxxxxxxxx the xxxxxxxxx ramifications xx these xxxxxxxxxx occurrences xxxx billing xxxxxxxxxxxxx to xxxxxxxxxx service xxxxxx shedding xxxxx on xxxxx diverse xxxxxxx on xxxxxxxxxxxx healthcare xxxxxxx quality xxxxxxx well-being xxx the xxxxxxxxx stability xx the xxxxxxxxxx sector xxxxxxxx this xxxxxxxx will xxxxx on xxxxxxxx comprehensive xxxxxxxxxx tools xxx mechanisms xx detect xxxxxxx and xxxxxxx healthcare xxxxx aiming xx fortify xxx regulatory xxxxxxxxxx and xxxxx reforms xxxxxxxxx to xxxxxxxxx fraudulent xxxxxxx effectively xxx final xxxxxxxxx is xx recommend xxxxxxxx aimed xx enhancing xxx regulatory xxxxxxxxx and xxxxxxx healthcare xxxxx thereby xxxxxxxxxxxx essential xxxxxxxx to xxxxxxx discussions xx healthcare xxxxxxxxx and xxxxxxx the xxxxxxxxxx for xxxxxxxxxx changes xxxxxxxx This xx from xxx ACFE xxxxxxxx This xx here xx demonstrate xxxx should xx here xx it xxxx you xxxx was xxx investigator xxxxxxx together xxxx report xxx government xxxxxxxxx you xxxx access xx may xxxx supply xxx names xx the xxxxxxxx involved xxxxxxx those xxxx It xxx say xxxx there xxx also xxxxx law xxxxxxxxxxx involved xxxxxxx that xxxxxxxxx it xxxxxxx that xxxxx was xxx primary xxxxxxxxxxxx include xxxx Individuals xxxxxxxxxxx can xx substituted xxxx those xxx were xxxxxxx in xxx case xxxxxxxx for xxxxxxxxx the xxxxxxx Fraudulent xxxxxx Team xxxxxxx Investigator xxxxx Donovan xxx US xxxxxxxx Investigator xxxx Rogers xxx Assistant xx Attorney xxxxxxxxxxxx Richard x Myrus xxx Acting xxxxxx States xxxxxxxx Investigator xxxxxxx A xxxxx USAO-RI xxxxxxxxxx Data xxxxxxxxxx and xxxxxx Obtain xxx analyze xxx complaint xx indictment xxxxx by xxx Department xx Justice xxxxxxx to xxx alleged xxxxxx care xxxxx scheme xxxxxx financial xxxxxxx claims xxx documents xxxx various xxxxxxxxxx programs xxxxxxxxx companies xxx relevant xxxxxxxx involved xxxxxxx and xxxxxxx any xxxxxx records xx reports xxxxxxxxx the xxxxxxx nurse xxxxxxxxxxxxxx activities xxx related xxxxxxxxx transactions xxxxxxxxxx and xxxxxxxxx Conduct xxxxxxxxxxxxx interviews xxxx pertinent xxxxxxxxxxx involved xxxx as xxxxxxxxx company xxxxxxxxxxxxxxx healthcare xxxxxxx administrators xxx witnesses xxxxxxx to xxx case xxxxxx in xxxxxxxxxxx with xxxxxxxxxx professionals xxxxxxxx including xxxxx nurse xxxxxxxxxxxxx or xxxxxxxxxx personnel xxxxxxxx with xxxxxxx systems xxx fraudulent xxxxxxxxx Legal xxxxxxxxxxxxx Explore xxx legal xxxxxxx or xxxxxxxxxxxxxx penalties xxxxxxx by xxxxxxxx federal xxxxxxxx such xx the xxxxxxxxxx of xxxxxxx and xxx USAO-RI xxxxxxx the xxxxxxx nurse xxxxxxxxxxxx Examine xx the xxxxxxxxxx has xxxx barred xx subject xx civil xxxxxxx by xxxxxxxxxx bodies xxxx the xxx FINRA xx CFTC xxxxxxxx Document xxxxxxx Survey xxxxxxxx mainstream xxxxx sources xxxx Forbes xxxx Street xxxxxxx and xxxxxxxx government xxxxxxxx including xxx DOJ xxx and xxxxx pertinent xxxxxxxxxxx to xxxxxx additional xxxxxxxxxxxx information xxxx research xxxxxxxx aims xx provide x comprehensive xxxxxxxx and xxxxxxxxxxxxx of xxx alleged xxxxxxxxxx healthcare xxxxxx encompassing xxxxx actions xxxxxxxxx transactions xxx associated xxxxxxxxxx measures xxxxx by xxxxxxxx agencies xxx authorities xxxxxxxx These xxxxxxxxx are xxx to xx answered xxx or xx These xxxxxxxxx are xxxx solely xx help xxx understand xxxx information xxxxxx be xxxxxxxx in xxxx section xx your xxxxx This xxxx be xxxxxxx in xxxxxxxxx format xx NOT xxxxxxx the xxxxxxxxx in xxxx paper xx they xxx in xxxx paper xxx will xxxx points xxxx should xx several xxxxx the xxxx of xxx report xxxx was xxx fraud xxxxx that xxx suspected xxxx are xxx details xx the xxxx How xxx it xxxxxxx out xxx did xxxx What xxx their xxxxxxxx that xxxxxxx the xxxxx Where xxx this xxxxxxxxxxxxxx Was xx civil xx criminal xx both xxxx is xxx relevant xxxx period xxxx is xx documented xx have xxxxx place xxxxxxxxxx of xxxxxx as xxxxxxxxx in xxx documents xxxxxx the xxxxx examination xxx team xxxxxxxx reviewed xxx insurance xxxxx and xxxxxxxxx a xxxxx trial xxxx several xxxxxxxxxxxx from xx Upon xxxxxxxxxxx Alander x Istomin xx the xxx of xxxxxxxxx to xxxxxxx routinely xxxxxxxxx devised xxxxxx insurance xxxxxx for xxxxxxxxx patient xxxxxxx within xxx served xxxxxx of xxxx Greenwich xxx York xxx Florida xxxxx the xxxxxxx laid xxxxxxxx healthcare xxxxx mail xxxxx and xxxxx laundering xxxxxxx National xxxxxx Care xxxxx Enforcement xxxxxx According xx the xxxxx examination xx the xxxxxxxxxxxx ALEXANDER xxxxxxx a xxxxxxxxxx nurse xxx director xx Rhode xxxxxx Diagnostic xxxxxx is xxxx recognized xx Advanced xxxxxxxx Registered xxxxx Nurse xxxxxxxxxxxx in xxxxx health xxxxxxxxxx Substance xxxxxxxxxxxx license xxxxxxxxx Nurse xxxxxxxxxxxx APRN-CNP xxx Advanced xxxxxxxx Registered xxxxx CSR-Aprn xxx diagnostic xxxxxxx were xxxxxxxxx for xxxxxxx the xxx York xxxxxx served x similar xxxxxxx and xxx not xxxxxxxx for xxxxxxx care xx order xx have x better xxxxxxxxxxxxx of xxx event xxx examiners xxxxxxx the xxxx from xxx legal xxxxxxxxxx defining xxx structure xx the xxxxxxx which xxxxxxxx several xx the xxxxxxxxx definitions x Medicare xxxxxxx is xxxxxxxx to xxxxx individuals xxxx the xxx of xx disabled xx provide xxxxxx care xxxxxxx The xxxxxxxxxxx shows xxxx ALEXANDER xxxxxxx is xxx of xxx certified xxxxxxxx providers xx New xxxx Florida xxxx program xx initiated xxxxx the xxxxxx States xxxxxxxxxx of xxxxxx and xxxxx Services x H x through xxxxxxxxxx C x S xx Centers xxx Medicare xxx Medicaid xxxxxxxx National xxxxxx Care xxxxx Enforcement xxxxxx United xxxxxx of xxxxxxx Department xx Justice xxx examiners xxxxxxxxx that xxx a xxxxxxxx to xx certified xxxx must xx enrolled xx C x S xxx their xxxxxxxx will xxxxxx with x unique xxxxxxxx number xxxxxxx program xxxx B xxxxxxxx beneficiaries xx be x part xxxxxxxxx of xxx program xx contributing xxxxx Medicare xxxxxxx remaining xxx is xxxxxx by xxx provider xxxx beneficiaries xxxxxx States xx America xxxxxxxxxx of xxxxxxx Nonetheless xxx examination xxxx covered xxx private xxxxxx insurers xxxxx the xxxxx required xxxxxxxxxx of xxxxxxxxxxxxxxxx like xxxxx or xxxxxx or xxxxx programs xxx are xxxxxxxxxxxxxxxx program xxxx are xxx by xxx premium xxxx by xxxxxxxxx and xxxxxxxxx The xxxxxxxxxxx included x particular xxxxxxxxxxxx plan x S x Administrative xxxxxxxx Only xxxxxxx the xxxxxxx funds xxx own xxxxxxxxx program xxxxx outsourcing xxxxxxxxxxxxxx services xxx also xxxxxxx its xxxxxxxxx by xxxxxx their xxxxxx and xxx employers xxx the xxxxxxx insurer xxx the xxxxxx National xxxxxx Care xxxxx Enforcement xxxxxx The xxxxxxxxxxx drew xx certain x S x 's xxx are xx an xxxxxxxxxxx in xxxxx such xx Mason xxxxxxx Dell xxx AstraZeneca xxxxxxx Aetna xxxxxxxx as x claim xxxxxxxxx to xxxxx employees xx behalf xx the xxxxxxxxxxxxxxx companies xxx later xxxx a xxxxxxxxxxxxx for xxx examination xxxxxxxx that xxxxx A x O xxxxxxxxx plans xxx the xxxxxxxxx by xxxxxxx insurers xxx defined xx health xxxx benefit xxxxxxx under xxxxx United xxxxxx Code xxx b xxxxx practitioner xxxxxxx in xxxxxxx million xxxxxx care xxxxx scheme xx ISTOMIN's xxxx he xxx submitting xxxxxx to xxxxxxx commercial xxxxxxxxx carriers xxxx included x S x arrangements xxxx Manson xxxxxxx Dell xxx AstraZeneca xxxxxx the xxxxxxxxxxx the xxxxxxxxx stated xxxx ISTOMIN xxx a xxxxxxxxxxxxxxxxx provider xxx private xxxxxxxxxxxxxxxx insurers xxxx Aetna xxxxxx United xxxxxxxxxx Cigna xxxx FL xxx BCBS xx wherein xx the xxxxxxxx is xxx abided xx any xxxxxxxx or xx agreement xxxx is xx there xxx non-participating xxxx are xxxxxxxxxx pursuant xx the xxxxxxx plan xxxxxx States xx America xxxxxxxxxx of xxxxxxx According xx the xxxxx assessment xxxxxxx had xxxxxxxxx intended x devise xxxxxx and xxxxxxxx Claims xxxx made xxx reimbursement xxxxxxx commercial xxxxxx insurers xxxxx the xxxxxxxx program xxxxxxxxxx a xxxxx claim xx initially xxxxx the xxxxxxxxxx were xxxxx Title xxxxxx States xxxx Section xxxxx after xxx examination xxx final xxxxxx stated x total xxxxx amount xx National xxxxxx Care xxxxx Enforcement xxxxxx The xxxxxxx stem xxxx a xxxxxx spanning xxxx February xx the xxxxxxx wherein xxxxxxx allegedly xxxxxxxxx fraudulent xxxxxx for xxxxxxx services xx commercial xxxxxx insurers xxx Medicare xxxxxx of xxxxx The xxxxxx involved xxxxxxxxxx false xxxxxx for xxxxxxxxxxxxx misrepresenting xxxxxxx services xx medically xxxxxxxxx and xxxxxxxxx billing xxx services xxxx were xxxxx provided xxxxxxx allegedly xxxxxxx in xxxxxxx irregularities xxxxxxxxx claiming xx provide xxxxxxxx in xxxxxxxxx where xx was xxx present xxxx in xxxxxxx conducted x transaction xxxxxxx interstate xxxxxxxx that xxxxxxxx unlawful xxxxxx care xxxxx in xxxxxxxxx of xxxxx United xxxxxx Code xxxxxxx a x i xxx United xxxxxx of xxxxxxx Department xx Justice xxx examination xxxxxxxx ISTOMIN xxx mail xxxxx offenses xxxxx U x C x C xxx U x C x Individuals xxx Entities xxxxxxxx Alexander x Istomin xxxxxxxxxx Nurse xxxxxxxx of xxxx and xxxxxxxxxx with xxx York xxxxxxx Center xxx N x in xxxxx Health xxxxxxxxxx and xxxxxxxxx PLLC xxxxx Island xxxxxxxxxx Center xxxx Location xx East xxxxxxxxx Rhode xxxxxx New xxxx Medical xxxxxx Locations xx New xxxx and xxxx Lauderdale xxxxxxx N x in xxxxx Health xxxxxxxxxx and xxxxxxxxx PLLC xxxxxxxxx in xxx York xxx Uniondale xxx York xxxxxxx Practices xxxxxxx and xxxx submitted xxxxxx to xxxxx United xxxxxx Care xxxxxx and xxxxxx using xxxxx Island xxx New xxxx locations xxx defendant xxxxxxxxx billed xxxxxxxx and xxxxxxxxxx insurers xxx services xxxxxxxx in xxxxxxxxx states xxxxxxxxx when xx was xxx of xxx country xxxxxxxx Allegations xxxxxxx knowingly xxxxxx copayments xxx Medicare xxxxxxxxxxxxx a xxxxxxxx prohibited xx Medicare xxxxxxxx Health xxxx Fraud xxxxxxxxxxx Action xxx defendant xxxxxxxxxx health xxxx reimbursement xxxxxx to xxx office xxxxx in xxxx Greenwich xxxxx Island xxxxx practitioner xxxxxxx in xxxxxxx million xxxxxx care xxxxx scheme xxxxxxx conducted xxxxx laundering xx sending x check xx J x T xxxxxxxxxx L x C xxxxx funds xxxx the xxxxx Nurse xxxxxxxxxxxx charged xx alleged xxxxxxx health xxxx fraud xxxxxx Chronology xx Key xxxxxx February x Present xxxxxxx commencement xx the xxxxxxxxxx scheme xxxx - xxxxx Dates xx mail xxxxx involving xxxxxx from xxxxx and xxxxxx Healthcare xxxxxxxx Date xx money xxxxxxxxxx involving x check xx J x T xxxxxxxxxx L x C xxxxxxxxxx Allegations xxx government xxxxx the xxxxxxxxxx of xx U x currency xxxxxxxxxxxx gross xxxxxxxx traceable xx the xxxxxxxxxx United xxxxxx of xxxxxxx Department xx Justice xxxxxxxxxxxx the xxxxxxxxxx aims xx seize xxx other xxxxxxxx of xxxxxxx equal xx the xxxxx of xxx forfeitable xxxxxxxx Conclusion xxx findings xxxxxxx a xxxxxxx fraudulent xxxxxx involving xxxxxxxxxx billing xxxxxxxxx misrepresentation xx services xxx money xxxxxxxxxx The xxxxxxxxxxxx case xx built xx a xxxxxxxx examination xx Istomin's xxxxxxxxxx across xxxxxxxx states xxx entities xxxxxxxxxx a xxxxxxxxxx effort xx defraud xxxxxx care xxxxxxx programs xxxxxxx This xxxxxxx should xx one xx two xxxxxxxxxx and xxxxxx succinctly xxxxxxxxx the xxxxxxx of xxx fraud xxxxxxxxxxx It xxxxxx be xxxxxxx to xxx outcome xxxxxx at xxx end xx the xxxxxxxxx Summary xxxxxxx Impact xx Organization xxxx The xxxxxx section xxxxxx describe xxx the xxxxx impacted xxx victim xxxxxxxxxxxx including xx estimate xx the xxxxxx losses xx any xxxxx type xx tangible xx intangible xxxxxx already xxxxxxxx or xxxx may xxxxx in xxx future xxxxxxxxxxxxxxx This xxxxxxx is xxxxxxxx in xxxx instances xx might xx preferable xx discuss xxxxxxxx measures xx specific xxxxxxxxxxxxxxx in x separate xxxxxxxx If xxxx section xx included xx should xxxxx what xxxxxxxxx action xx necessary xx recommended xxxxxxxxx remedial xxxxxxxx such xx a xxxxxx of xxxxxxxx controls xxxxxxxxxxxx of x hotline xxxxxxxxx security xxx Reference xxxx In x formal xxxxxx there xx rarely xxxx for xxxxxxxxxx Those xxxxxxxx would xxxxxxxxx be xxxxx citations xxxxxxx in xxxx report xxxxxxxx must xxxxxxx every xxxxxxxx used xxxxx according xx the xxxxxxxxxx and xxxxxxxx guide xx the xxxx book xxxxxxxx managers xxx not xxxxxxx because xxxx make xxxxxxxx Incorrect xxxxxxx will xxxx points xxxx assignment xxxxxxx to xxx only xxxxxxx documents xx sources xx cases xxxx include xxxxxxx countries xxxxx sources xxx allowed xxxx on xxx approval xx the xxxxxxxxxx Non-approved xxxxxxx will xxxx points xxxx must xx in xxx format xx indicated xx the xxxxxxxxxx and xxxxxxxx guidelines xxxxxxxxxx National xxxxxx Care xxxxx Enforcement xxxxxx Criminal xxxxxxxx September xxxxx www xxxxxxx gov xxxxxxxx criminal-fraud xxxxx district-summaries xxxxx practitioner xxxxxxx in xxxxxxx million xxxxxx care xxxxx scheme xxxxxxxx of xxxxx Island xxxxx Practitioner xxxxxxx in xxxxxxx Million xxxxxx Care xxxxx Scheme xxxxxx States xxxxxxxxxx of xxxxxxx August xxxxx www xxxxxxx gov xxxxxxx pr xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx -million-health-care-fraud-scheme xxxxxx States xx America xxxxxxxxxx of xxxxxxx Justice xxx United xxxxxx of xxxxxxx v xxxxxxxxx E xxxxxxx https xxx justice xxx media xx inlineMore Articles From Research
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