The F Files

Just in time for spooky season, The F Files is uncovering the mysteries of psychotherapy documentation and coding! From suspicious session times and missing interventions to unclear treatment goals and incomplete progress notes, our team explores common audit findings and the red flags reviewers should watch for.Tune in for practical insights, real-world examples, and a little Halloween humor as we examine what it takes to properly document and support psychotherapy services.

In Part 2 of our SIU Roundtable, we explore how Medicare, Medicaid, and commercial payers approach fraud investigations when claims and schemes cross payer lines. Hear real-world perspectives on coordination of benefits, investigative responsibilities, communication gaps, and why collaboration matters in the fight against fraud, waste, and abuse.

Same mission. Different playbooks.In this episode of The F Files, we bring together investigators from vendor, payer, and government environments to compare how fraud investigations really work. From leads to outcomes, hear how perspective shapes every step. Part 2 coming soon.

Too-good-to-be-true promises often hide the biggest fraud schemes. In this episode, Mandi and Daphne explore the “pot of gold” illusion in fraud, from leprechaun folklore to the real-world deception behind the Theranos scandal. The episode also features a conversation with HCFS team member Paula about HCFSElevate, the upcoming user conference in Austin, where guest speaker and whistleblower Tyler Schultz will share the story behind exposing Theranos and why investigative professionals remain essential to uncovering fraud.

From bloodletting and Botox to ghost doctors and falsified lab codes, this episode exposes the dark side of "wellness" clinics and concierge med spas. Join hosts Daphne Krout and Mandi Cook as they uncover firsthand accounts of risky procedures, insurance manipulation, and outright fraud. Featuring a special guest RN turned fraud fighter who shares what really happened behind closed doors.

Non-emergency transport might sound routine, but it's become a hotspot for fraud. In this episode of The F Files, hosts Daphne and Mandi dig into schemes involving falsified mileage, upcoded services, and even transport crews lacking certification. From bizarre van rides to six-figure fraud cases, they reveal how something as simple as a ride to dialysis can turn into a $6 million scam. Whether you're in SIU, compliance, or analytics, get ready to uncover red flags and sharpen your detection game.

Phantom providers haunt healthcare systems — billing for services never rendered, using identities that don’t exist. In this episode, hosts Daphne Krout and Mandi Cook pull back the sheet on these ghostly schemes and reveal how SIUs and analytics teams can expose the fraud behind the facade.

In this special handoff episode, EVP Karen Weintraub passes the torch to our new hosts and shares what’s ahead for the Healthcare Fraud Shield podcast - including a new identity!

Season 4 will be a series of interviews with members of our own Special Investigations Unit.  We will showcase different members of our team including the director, investigators, coders and clinicians who will join each episode for a fun reflective chat on their first case/various experiences and lessons learned.  In this episode, Kelli Hess who has vast experience investigating both Medicare and Commercial plan data will walk through her background in the FWA industry and one of her first experiences. If you would like more information, contact us at [email protected]

Season 4 will be a series of interviews with members of our own Special Investigations Unit.  We will showcase different members of our team including the director, investigators, coders and clinicians who will join each episode for a fun reflective chat on their first case/various experiences and lessons learned.  In this episode, Maria Seedorff who has a wealth of information will walk through her background in the FWA industry and one of her first experiences. Maria is a chiropractor, a Certified Professional Coder, and Accredited Health Care Fraud Investigator and one of our FWA gurus.