Eric, Wade and Matt discuss how identifying the next generation of investigators can start with finding the right interns and developing their skills to suit the organization.

Matt, Eric and Wade discuss a very concerning public health criminal case involving the diversion of HIV medications, the repackaging of the medications, and mislabeling medications that are needed for life altering diseases.

Eric, Wade and Matt discuss a nearly $54m fraud involving, yes, DME, false scripts and kickbacks.  While this may be a limiting investigation for an SIU, there are some things you can do with your team and look to make lemonade out of lemons.

Eric and Matt have a follow up discussion on ABA therapy, as a carry over from last week.  We discuss an OIG audit of Colorado and the fact they had a 93% error rate on areas involving provider documentation.  Documentation lapses can be the most difficult to ascertain at the time of billing, and human intelligence is a key part of the investigative metric.

Eric, Wade and Matt discuss the on going ad evolving ABA frauds.  Keeping up with cases, learning the fraud schemes, and ensuring you are a SME in “everything” is a challenge.

Eric, Matt and Wade discuss a recent Indictment and Non-Prosecution Agreement (NPA) involving a device manufacturer involved in providing Medicare beneficiaries an inordinate of supplies that are used with a Medicare covered TENS machine.

Eric and Matt discuss a recent $120 million fraud scheme that encompassed kickbacks and fraudulent prescriptions and payments to attendees who were steered to a particular pharmacy to get their bogus prescriptions filled.  In this episode, we highlight the issues of difficulty in conducting these investigations, the cultural divide and some data that can demonstrate suspect patterns.

Eric, Wade and Matt discuss the important role the SIU plays, how the overall plan sees the role of the SIU, and measuring both individual success, SIU success and plan success in controlling costs, finding operational efficiencies and incorporating intangible and tangible ROI.

Eric, Wade and Matt revisit probe and statistical sampling and how the decision to do either will have a workflow effect and can create nuanced delays in resolving cases and investigations.

Eric, Matt and Wade continue to revisit a previous FWA scheme involving TCD and medical necessity.  We have discussed this area as a program weakness and the involvement of manufacturers of the devices, the payments of kickbacks and how data can demonstrate that FWA persists.