OIG Roundtable (Formerly Retro Fraud)

Oct 24 2024 9 ep. 40 mins 4
OIG Roundtable (Formerly Retro Fraud) Podcast artwork

Former HHS-OIG Senior Special Agent Eric Rubenstein discusses historical fraud cases that either he or others investigated and how the "circus does not change, only the clowns do." In these podcasts, Eric and his guest discuss how the facts of the case have significance to today’s fraud schemes.

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Episode 100: A Very Special Episode

Oct 24 2024 126 mins  
For the 100th episode special of the OIG Roundtable podcast, Jeanmarie Loria, along with several surprise guests, invades the show for an exciting and unexpected twist! The episode dives into lively conversations about healthcare compliance, fraud prevention, and regulatory oversight, featuring stories and insights from some of the top voices in the field. This milestone episode ce

Episode 99: Do Corporate Integrity Agreements Have Any Effect on Deterrence?

Oct 17 2024 34 mins  
Eric, Wade and Matt discuss the recent settlement agreement with Teva for $250 million, on top of two other settlements since 2022. Do prosecutions, settlements and penalties have an aeefect on FWA behavior? We think not.

Episode 98: Data Always Fails Us

Oct 10 2024 29 mins  
Eric and Wade discuss a May 2024 OIG-OEI study on DME for the period 2018-2020. Over $1 billion was paid for DME during this period, and one doctor, a radiologist in California, ordered more than 20,000 DME products for patients in 44 states. It is a head scratcher for sure.

Episode 97: Staffing Trials and Tribulations

Oct 03 2024 32 mins  
Eric, Wade and Matt discuss the current climate in staffing at SIUs and the challenges in obtaining that "perfect" position, but after a career at the OIG and in moving from one payor to another.

Episode 96: Companion Document Retrieval Challenges

Sep 25 2024 25 mins  
Eric, Wade and Matt discuss the challenges of recovering records for ancillary services. In this episode, we discuss the CMS requirement that ancillary providers obtain medical records for diagnostic and other tests to support medical necessity for that test. This can be a challenge in the SIU space, and data can help overcome the lack of provided documents from a pre or post pay r

Episode 95: “Too Big To Fail” How Qui Tams are essential in the FWA Space

Sep 19 2024 36 mins  
Eric, Wade and Matt discuss the recent settlement with Walgreens and the collateral implications of settlements in the Qui Tam space.

Episode 94: Is Adding a Diagnoses to a Medicare Advantage Patient FWA or a Positive Step in Social Determinants of Health (SDOH)

Sep 11 2024 30 mins  
Eric and Wade discuss a recent Wall Street Journal article that discussed the fact that Medicare Advantage payors are having contracted healthcare providers affirmatively visit, examine and diagnose members with conditions that were potentially unknown to the members' primary care provider. Is this manipulation of risk scores or SDOH related?

Episode 93: Compliance is a Two Way Street

Sep 06 2024 26 mins  
Compliance is a requirement under the ACA for Medicare and Medicaid providers. Did you know you can be financially penalized if you do not have "an effective compliance program?" It is a two way street because #SIU teams also need to live in a compliant environment. We explore both sides of the street on this, and hope no one crosses the street.

Episode 92: Promises Promises from Vendors

Aug 29 2024 26 mins  
Eric, Wade and Matt discuss the importance of being realistic from a vendor perspective. Often vendors promise the moon and the stars, but usually underdeliver. We discuss, in depth, the importance of expectations and level-setting for realistic results.