Healthcare Forensics Q&A
What is healthcare forensics?
What skills set BlickenWolf apart as healthcare forensics consultants?
What is the goal of healthcare forensics?
How useful is healthcare forensics to a healthcare provider?
When does a healthcare provider need to bring in a healthcare forensics consultant?
What are the short-term and long-term trends in healthcare forensics?
What is healthcare forensics?
Not to be confused with forensic medicine, forensic accounting, or computer forensics, healthcare forensics is a unique and evolving investigative science involving healthcare systems and entities of all types designed to determine cause, cure, and liability of inappropriate activity within any type of healthcare organization.
What skills set BlickenWolf apart as healthcare forensics consultants?
BlickenWolf is one of the very few healthcare forensics consulting firms in the United States and is one of the oldest in terms of experience and depth. The BlickenWolf team’s exclusive combination of skills and experience in healthcare operations, accounting and billing, and law enforcement and prosecution is unparalleled. Principal Kenneth Blickenstaff is a former director of a Medicaid fraud control unit, a former law enforcement officer assigned to healthcare fraud prosecution, and past president of both the National Association of Medicaid Fraud Control Units and the Chicago Chapter of the Association of Certified Fraud Examiners.
Principal Carmen Wolf is a registered nurse and former manager of the Milwaukee Heart Institute and is an expert regarding the inner workings of a healthcare organization. Klinton Brown and Debra Slaughter have a combined 40 years of expertise in revenue cycle work and patient accounting.
To thoroughly investigate potential false claims and other inappropriate or improper activity within a healthcare organization’s system, BlickenWolf uses a specific methodology with well defined processes designed to achieve recognized goals. Depending on the situation, we typically request data and documents from the client, conduct in-depth interviews, and review systems on-site as needed.
What is the goal of healthcare forensics?
Our goal is to scientifically investigate what went wrong, the period of time the error occurred, and to estimate risks associate with licensure, quantification of potential repayments, and disclosures to governmental agencies. In addition, our operational experience allows us to not only make recommendations to change processes and systems to correct the problem, but we are adept at working hand-in-hand with our clients to make the changes a reality.
How useful is healthcare forensics to a healthcare provider?
The most helpful aspect of healthcare forensics is the mathematical and statistical information it reveals. Such information allows us to quantify any over, or under, payments or billing discrepancies.
When does a healthcare provider need to bring in a healthcare forensics consultant?
A healthcare provider will want to consider hiring a healthcare forensics consultant when being proactive, reactive, or responsive.
Proactive:
When performing routine compliance and auditing, a provider may suspect wrong-doing. Should this be the case, an immediate healthcare forensics investigation will assist in pinpointing a potential error. BlickenWolf healthcare forensics consultants will then work with the provider to correct the problem.Reactive:
If or when healthcare law enforcement officers contact a provider, a healthcare forensics consultant should be brought in immediately. We help the provider identify what went wrong and over what time period, as well as estimate risks associated with licensure, quantify potential repayments, and accurately disclose activities to governmental agencies.Responsive:
Once an issue is identified and the provider is correcting the error, it is valuable to have a healthcare forensics consultant review the revised processes to prevent further errors. Such activity and third party review will also be viewed by government agencies as very cooperative.
What are the short-term and long-term trends in healthcare forensics?
Healthcare forensics is a very new discipline within healthcare compliance. It is currently an evolving science with no higher education institution yet providing degrees or certificates in the area. BlickenWolf is one of the very few healthcare forensics consulting firms in the United States and continues to be on the cutting edge of its evolution. Data, such as PEPPER, is readily available. As healthcare forensics evolves, healthcare law enforcement officers are becoming more sophisticated in gathering, understanding, and analyzing the data. As this trend continues, healthcare providers will want to use and understand this methodology to maintain “clean claims” and to continually comply with healthcare regulations.
BlickenWolf Healthcare Forensics Services
