OIG Roundtable (Formerly Retro Fraud)

Episode 168: No Honor Amongst Thieves. Brothers in Arms

Eric Rubenstein — Wed, 15 Apr 2026 18:54:46 +0000

Eric, Wade and Matt discuss a recent pharmacy fraud case. The fraud went on for five years and resulted in the plea of the owner of the pharmacy, and an indictment of the Pharmacist in Charge (PIC), who turned out to be the brother of the owner. Thanksgiving will definitely be unique.

Episode 167: When greed overcomes common sense, Hippocratic Oath and patients first

Eric Rubenstein — Wed, 08 Apr 2026 18:16:06 +0000

Eric and Matt discuss a recent sentencing of a doctor who took greed to another level. By altering certain CPAP devices, the provider sought to overcome identified issues that resulted in a recall of a particular CPAP. The FDA recall highlighted that use of the particular CPAP could lead to respiratory issues and cancer. The provider, however, ignored this, and sought to remove the offending parts and dispense them to his patients, all the while insurance paid the costs.

Episode 166: Interns are a Valuable Asset

Eric Rubenstein — Wed, 01 Apr 2026 17:52:56 +0000

Eric, Wade and Matt discuss how identifying the next generation of investigators can start with finding the right interns and developing their skills to suit the organization.

Episode 165: Drug Diversion to Another Level

Eric Rubenstein — Thu, 26 Mar 2026 01:54:03 +0000

Matt, Eric and Wade discuss a very concerning public health criminal case involving the diversion of HIV medications, the repackaging of the medications, and mislabeling medications that are needed for life altering diseases.

Episode 164: Wash, Rinse and Repeat (again and again)

Eric Rubenstein — Wed, 18 Mar 2026 23:43:03 +0000

Eric, Wade and Matt discuss a nearly $54m fraud involving, yes, DME, false scripts and kickbacks. While this may be a limiting investigation for an SIU, there are some things you can do with your team and look to make lemonade out of lemons.

Episode 163: Colorado’s OIG Audit of ABA

Eric Rubenstein — Wed, 11 Mar 2026 20:32:21 +0000

Eric and Matt have a follow up discussion on ABA therapy, as a carry over from last week. We discuss an OIG audit of Colorado and the fact they had a 93% error rate on areas involving provider documentation. Documentation lapses can be the most difficult to ascertain at the time of billing, and human intelligence is a key part of the investigative metric.

Episode 162: ABA Therapy Issues

Eric Rubenstein — Wed, 04 Mar 2026 23:19:06 +0000

Eric, Wade and Matt discuss the on going ad evolving ABA frauds. Keeping up with cases, learning the fraud schemes, and ensuring you are a SME in “everything” is a challenge.

Episode 161: Wash, Rinse and Repeat—Auto-Refill Schemes Keep Popping Up

Eric Rubenstein — Wed, 25 Feb 2026 20:26:28 +0000

Eric, Matt and Wade discuss a recent Indictment and Non-Prosecution Agreement (NPA) involving a device manufacturer involved in providing Medicare beneficiaries an inordinate of supplies that are used with a Medicare covered TENS machine.

Episode 160: Adult Social Daycare FWA

Eric Rubenstein — Wed, 18 Feb 2026 23:04:12 +0000

Eric and Matt discuss a recent $120 million fraud scheme that encompassed kickbacks and fraudulent prescriptions and payments to attendees who were steered to a particular pharmacy to get their bogus prescriptions filled. In this episode, we highlight the issues of difficulty in conducting these investigations, the cultural divide and some data that can demonstrate suspect patterns.

Episode 159: Does the Payor See the Value in the SIU

Eric Rubenstein — Thu, 12 Feb 2026 21:48:19 +0000

Eric, Wade and Matt discuss the important role the SIU plays, how the overall plan sees the role of the SIU, and measuring both individual success, SIU success and plan success in controlling costs, finding operational efficiencies and incorporating intangible and tangible ROI.