OIG Roundtable (Formerly Retro Fraud)
by Eric Rubenstein
Latest episode
Episode 196: Changes are a Comin’—CMS to Issue Permissive Exclusions
Episode 196: Changes are a Comin’—CMS to Issue Permissive Exclusions
About this podcast
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.
Episodes
- Episode 196: Changes are a Comin’—CMS to Issue Permissive Exclusions · 29 minEric, Matt, and Wade discuss a recent authority re-extended to CMS as it pertains to permissive exclusion authorities. While CMS had previously had such authority, OIG maintained…
- Episode 195: NHCAA is Coming Soon · 28 minEric, Wade and Matt discuss how overwhelming participation can be at the premiere healthcare fraud conference can be, if you are not prepared. Proper planning, meeting…
- Episode 194: When CMS Directives for Reviews Affect Commercial Plans · 25 minEric and Wade discuss how CMS’ recent additions to the RAC audit protocols to include an additional 20 topics can have an implication on how plans run data, determine spikes and…
- Episode 193: The disparity between federal and state prosecutions · 33 minEric, Wade and Matt discuss the huge disparity that can exist in healthcare fraud prosecutions that happen in state and federal courts. We discuss the importance of strong…
- Episode 192: Qui Tams Matter and Polices Still Need Reviewing · 28 minEric and Matt discuss a recent policy disseminated by the DOJ that discusses the sub-regulatory role of policies in the government space (LCD/NCD). While these polices do not…
- Episode 191: Participation loopholes in Medicare Advantage · 22 minMA plans are not required to reject claims from non-participating providers, while traditional Medicare requires providers to be enrolled in order to submit claims. This creates…
- Episode 190: Identity Theft and healthcare Fraud: Top of Mind · 25 minEric and Matt discuss a recent case where an individual engaged in identity theft and sought healthcare benefits under the stolen identity. This case is notable as the dollar…
- Episode 189: The Pig and the Python. How does an economic discussion for baby boomers relate to SIU operations · 23 minEric and Matt discuss the Pig and the Python and how the influx of baby boomers will have an effect on SIU operations and staffing needs.
- Episode 188: How a Kentucky Indictment Should be a Roadmap for Stop and Verify · 28 minEric and Wade discuss a recent indictment of a medical biller who engaged in a 6-year system Medicaid fraud scheme which included false billing for behavioral health providers…
- Episode 187: Incident To and the Ability to Think Logically · 26 minEric, Matt and Wade discuss the often overlooked need to capture the right documents in an Incident To investigation. Catch phrases in requests for documents such as “including…
