OIG Roundtable (Formerly Retro Fraud)

OIG Roundtable: Another Day, Another Multimillion Dollar Prosecution

Eric, Wade and Matt discuss the most recent DME tele-fraud scheme, using a digital platform to induce providers via kickbacks to order medically unnecessary DME. When will it end?

Eric, Wade and Matt discuss a personal care aide case with the resulting prosecution of the individual and $12,000 in fraud

Eric, Wade and Matt discuss a recent plea where a sales representative of a device manufacturer pleaded guilty to kickbacks relative to the sale and use of a TCD machine.

Eric, Wade and Matt discuss the huge fraud case involving 119 Amtrak employees. Amtrak, a quasi-governmental agency, that is self funded, identified a multi million dollar fraud scheme.

Eric, Matt and Wade discuss a recent Medicare Advantage Qui Tam that was file alleging kickbacks "cherry picking" and "lemon dropping." Three large MA plans have bene targeted for paying kickbacks to the TV brokers to induce referrals to those plans.

Eric, Wade and Matt discuss some of the nuances of conducting DME investigations. Does your payor have edits that are consistent with policy or regulation? Are you thinking ahead in your investigation planning on what you may need down the road? We address some key areas for consideration in these investigations.

Eric, Wade and Matt discuss the misnamed ADR and how it starts with the opening of an investigation. The process can be challenging for an SIU, and knowing what an appropriate ADR is can go a long way for ROI for a plan.

Eric, Wade and Matt discuss resume reviewing, interviewing in the virtual environment, mentoring and personal development in the SIU space.

Eric, Wade and Matt discuss Wade's favorite phrase:  how to do more with less.  We talk about preparing for budget cuts, operational planning and the importance of case management to identify ways to manage with fewer people