Advize
William J. Quandt, CFE, is a seasoned investigator with extensive experience in fraud, waste, and abuse (FWA) investigations within the healthcare sector and law enforcement. Currently serving as a Senior Investigator in the Special Investigations Unit at Advize since March 2023, Quandt previously honed skills as an Investigator and Program Integrity Analyst for SoftDev Incorporated, focusing on Medicare and Medicaid claims. Prior roles include Senior Investigator at Horizon Blue Cross Blue Shield of New Jersey, where investigative and analytical activities were conducted to uncover fraud, and Task Force Officer for the FBI Organized Crime Task Force, investigating transnational organized crime. Quandt's foundational experience as a Special Agent at the New Jersey State Commission of Investigation and as a Detective for the Waterfront Commission of New York Harbor underscores a robust background in addressing organized crime and regulatory offenses. Educational qualifications include a Master of Public Administration from Kean University and a Bachelor of Arts in Sociology and Political Science from the University at Albany.
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Advize
After nearly two decades of auditing large data sets and performing extrapolation for increased ROI for payers, Advize has shifted focus to building relationships with providers based on data and best practices. Our team has expanded our model of coding and billing audits focused on waste and abuse to examine fraud through Big-4 Data Analytics and OIG best practices. Audit and Support Services – Record Retrieval, Storage, Purge – Onsite record retrieval – Send request letters and other communications with providers – Secure file upload (SFU) – Records are stored securely and discarded in accordance with HIPAA recommendations and requirements – Minimum necessary PHI accessed – Record files are securely returned with audit result delivery – Corporate Integrity Agreements – Statistically valid sampling – Medical necessity and proper coding/documentation review – Audit Management and Quality Assurance Support – QA Review – Reporting and Results Delivery – Overpayment Recovery and Overpayment Support – Legal Support – Case building, expert witness, audit, reporting and testimony Review and Reporting – Reviews performed by highly experienced and credentialed auditors – Audit personnel work with a variety of healthcare personnel and patients. They should always conduct themselves in an acceptable, professional manner and adhere to ethical standards, confidentiality requirements, and objectivity. Auditors trained to completely document their findings and problems. – Perform verification of charges – What citations are important, and what policies are important? – Citation guidebook creation – Review of claims – Generation of preliminary audit results – Results delivery and collaboration with client – Report generation – Final Audit Results: – Contain final audit reporting, this reporting will have included the overpayment amount. – Review the next steps for the provider who was audited.