OIG Roundtable (Formerly Retro Fraud)

Eric Matt and Wade discuss what there two things have in common. The main point is that it is important to be consistent, rely upon experience and limit your liability with the things you have control over. Data, case managers and investigative process all require these three pillars for success.

Eric, Matt and Wade discuss leads and complaints that come to an SIU that are misdirected.  Whether it be identity theft, policy violations or cases generated from sunset codes, SIU teams should be ensuring that intake specialists, hotline agents and overall payment integrity teams are in alignment on proper case assignments.

Eric, Matt and Wade discuss some recent revelations on data from some of the work we are doing with PI/SIU teams. One area that we have noticed that seems to create a backlog of work is the volume of alerts, leads and general information that is not always actionable. We discuss this and strategize on how to be more effective in our data analysis.

This week, Eric welcomes Dan Olson, Payment Integrity Director to a special episode of the Roundtable.  With NAMPI just around the corner, Eric wanted to get Dan's take on the conference, making the most of the time and how to have an enjoyable and successful conference.  Enjoy this week's episode.

Eric, Wade and Matt discuss an indictment for $500 million involving what appeared to be a false website touting "free" COVID testing kits.  Wash, rinse and repeat.  The schemes are all the same.  Social engineering is alive and well.

Eric, Wade and Matt discuss a recent case out of NJ with a provider who was trading drugs for sexual favors with patients. An interesting case with some twists.

A special episode of the OIG Roundtable, Eric welcomes Jaysen Eisengrein back to the Roundtable. We also bring Adam Golden, our newest investigator to the SIU team and April Cameron, our NY SIU Director. We talk about mentoring, transitioning to working Medicaid cases and transitioning into the private sector from the government.

Eric, Wade and Matt discuss a very viable ROI technique to stem FWA early and maybe even before it starts. The use of physical surveillance can be a great tool in the SIU arsenal, but there are caveats.

Eric, Wade and Matt discuss in depth the big FWA news involving the arrests and charging (criminal and civil) of 324 defendants, including some cases that have a global hook to them.

Eric, Wade and Matt discuss a case out of Missouri where over a dozen individuals were charged for drug diversion, kickbacks, healthcare fraud and other things. This case is interesting as it was indicated in a press release that the patient records documented that the patients were selling or diverting their narcotic prescriptions. How does that get documented? Tune in and find out.