Any Fellow Nurses Ever Worked in Healthcare Fraud?

[lweave2]

HI Fellow Nurses- Need your input & feedback. Having an interview with company next Monday that is involved in Healthcare Fraud and wanted to ask if anybody has worked in this area of healthcare? I have 7 years of clinical research background experience with my patient care experience too & the company said that my research experience would be very transferable for this type of position. Would truly appreciate any insight or feedback from this nursing group.-Thank-You!-Lisa

[SHGR, MSN, RN, CNS]

You mean a company that is involved in fighting health care fraud, right?

Is it the OIG or private?

[Bubbles]

Occasionally as a Nurse Consultant / Case Manager I would get involved in insurance fraud cases where someone was attempting to blame injuries on an auto accident when injuries actually were from an earlier unrelated accident. There was a string of 'auto accidents' where various family members would cause an accident to happen and then try to claim injuries. The work required persistence in getting and reviewing medical records and being confident / assertive in giving your recommendations to your client who was either an attorney or an insurance adjuster. One needed ability to manage their schedule, be self directed, and have good writing skills. In auto liability cases and worker's compensation cases there are sometimes private investigators get involved. Don't know if this is the type of fraud you are referring to, but very interesting work!

[elkpark]

You mean a company that is involved in fighting health care fraud, right?

Is it the OIG or private?

Individual states also have programs for monitoring use of Medicaid funds and looking for inappropriate changes/fraud. A friend of mine from when I was a state surveyor works in that department of my state's healthcare licensing agency.