OIG Roundtable (Formerly Retro Fraud)

Episode 180: National Roundup

Eric Rubenstein — Wed, 08 Jul 2026 21:31:30 +0000

Eric and Matt discuss the most recent roundup, resulting in a large number of arrests, civil complaints, and the growing use of the OCIG CMP authorities to effect behavior change in the healthcare ecosystem.

Episode 179: When the kickbacks are Off the Beaten Path

Eric Rubenstein — Thu, 02 Jul 2026 00:27:30 +0000

Eric and Matt discuss a $30 million settlement that was predicted on several Qui Tams that were filed against a pathology lab for misrepresenting services, services not rendered and the payment of kickbacks in return for the samples to be sent.

Episode 178: Does the Punishment Fit the Crime?

Eric Rubenstein — Thu, 25 Jun 2026 01:40:48 +0000

Eric, Wade and Matt discuss a recent sentencing where the provider was sentenced to five years of probation for a $1m fraud scheme. Does that “take the wind out of the sails” of an investigator? How do you level set expectations with the C-Suite?

Episode 177: A cornucopia of FWA at a local pharmacy

Eric Rubenstein — Thu, 18 Jun 2026 03:35:22 +0000

Eric and Matt discuss a recent default judgement case where a Nebraska based pharmacy defaulted on a civil matter, resulting in over $3m in the judgement. Everything that you know about pharmacy FWA was part of the fraud; generic substitution, billing for unfilled prescriptions, failures in inventory, you name it.

Episode 176: $6 million for one beneficiary for skin grafts; that is a lot of skin

Eric Rubenstein — Thu, 11 Jun 2026 02:57:28 +0000

Eric and Matt discuss a recent case that was data driven. Over $46m in claims in a 7-month period, with all metrics being outside of the curve for the provider. Data is beginning to work properly in the FWA space.

Episode 175: The SMP is a Collaborative Team

Eric Rubenstein — Wed, 03 Jun 2026 21:37:55 +0000

Eric and Wade welcome Jean Stone to the OIG Roundtable. Jean, a fixture in Medicare and healthcare fraud, having spent 46 years with CMS in the FWA space. Jean is a force when it comes to FWA and her current work with SMP is extremely valuable.

Episode 174: Ambiguity in Policy? Shocking

Eric Rubenstein — Wed, 27 May 2026 19:15:41 +0000

Eric and Wade discuss a recent OIG study where ambiguity and confusion in understanding polices and billing guidance led to millions in inaccurate payments. This is not novel, and ambiguity and confusion have been the mantra for a lifetime.

Episode 173: Do you Dress for the Job You Have or the One You Want

Eric Rubenstein — Tue, 19 May 2026 17:16:44 +0000

Eric, Wade and Matt discuss the importance, or disregard for various certifications in the healthcare fraud, waste and abuse space. Whether it be a CFE, AHFI, CPC, CMPA or the alphabet soup of certifications and designations, plans and the industry look at these certifications very differently.

Episode 172: Same Circus and Different Clowns (again)

Eric Rubenstein — Thu, 14 May 2026 01:33:07 +0000

Eric and Matt talk about the $552 million genetic testing fraud case out of the West Coast. It seems like we are just hitting the repeat button on cases. Telemarketing, health fairs, door-to-door, all the usual playbook things for these frauds. Telling people they need to get the DNA swab for genetic tests (which run upwards of $10,000 in some cases) is how you make a lot of money quickly.

Episode 171: Kickbacks Disguised as a legitimate Payment is Still a Kickback

Eric Rubenstein — Wed, 06 May 2026 23:04:26 +0000

Eric, Matt and Wade discuss a recent press release out of Eastern District of NY where a pharmacy owner paid kickbacks to referring doctors for medically unnecessary prescriptions and masked the payments as rental agreements or salaries for the prescribing doctor’s staff. While these cases can be difficult to investigate from the SIU perspective, there are some key data points that can be relied upon to get the investigation moving forward.