OIG Roundtable (Formerly Retro Fraud)

Episode 183: Credentialling and Continuity from Plans and PBMs

Eric Rubenstein — Wed, 29 Jul 2026 20:53:37 +0000

Eric and Matt discuss a recent case out of the District of NJ, where a pharmacist and a pharmacy technician were involved in a broad fraud scheme that included falsifying documents in response to an audit, as well as billing for medications for the pharmacist and technician that were never dispensed and billed to their respective insurance.

Episode 182: Did the OIG Really Have a 12:1 ROI and Really Collect over $5 Billion?

Eric Rubenstein — Wed, 22 Jul 2026 01:03:59 +0000

Eric, Matt and special guest Dave Beachler discuss ROI from the government and the commercial plan space. ROI can be tricky and there may be some intangible factors to consider.

Episode 181: Credentialling is Top of Mind

Eric Rubenstein — Wed, 15 Jul 2026 22:30:03 +0000

Eric and Matt discuss recent developments in the MFCU space where at least two MFCUs were defunded by HHS. Credentialling of providers is top of mind as this is one of the first steps in ensuring the protection of the Medicaid programs.

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.