Last week marked one of my favorite weeks of the year—the NHCAA Annual Training Conference. This year, the conference was held in Dallas, prompting me to reflect on the past 10 years of my career in Healthcare Fraud. My first ATC was a decade ago, also in Dallas. Back then, I was relatively new to the Healthcare Fraud scene, but I was beyond excited to be a part of this new, albeit significant, family of investigators. That excitement persists to this day, as I feel truly honored to be in the company of so many accomplished individuals. If you have any doubts about how amazing our community of fellow fraud fighters is, it’s evident you didn’t attend the same sessions I did.
So, what’s new in healthcare fraud? GLP-1 Weight Loss Medications created a buzz. Pandemic Fraud was another hot topic. Additionally, there were the all-too-familiar DME fraud schemes, genetic testing, and pass-through lab billing. Have you examined pass-through billing for physical therapy services? You should. Facilities are collaborating with strip mall physical therapy clinics, passing the bill through the hospital. Imagine the surprise when members receive bills for facility cost shares after receiving services in a strip mall between the nail salon and sandwich shop. I digress.
As I listened to these presentations, I began to take note of the presenters’ passion for their topics. Let’s face it—fighting healthcare fraud is like a game of Whac-A-Mole. I can share all the new fraud trends and schemes, but as soon as you grasp GLP-1, a new mole pops up, requiring you to learn how to navigate and “whac” that one down too. So, I decided to delve deeper into what makes a good investigator. The passion I witnessed in those presenters’ eyes was nothing more than a reflection of the natural curiosity of a good investigator. It’s an instinct that compels people to seek new information and learn more about something or someone else. This natural curiosity allowed the Western District of Missouri to charge a State Lawmaker for COVID-19 Fraud, a Stem Cell Fraud Scheme, and Illegally Distributing Prescription Drugs. As the OIG Agent stated, “It all started with a Facebook post.” While that post may not have meant much to 99% of its viewers, it was enough to trigger the natural curiosity of a healthcare fraud investigator, and thankfully, it did! If you missed that presentation, you missed out. Check out the DOJ press release for Patricia Derges.
The Keynote Speaker, Linda Kaplan Thaler, said it best when she emphasized that you must have the grit to be great! In any profession, grit and grind are necessary for success. For investigators, add curiosity to that equation, and you have a recipe for success.
My colleague Eric Rubenstein joined me and presented with one of Advize’s client payer SIU directors on the importance of Public-Private Partnerships (the interaction between law enforcement and SIU communities) and how that collaboration can generate high-quality leads for the law enforcement community. While this presentation was niche, both in its audience and discussion points (geared toward the SIU management community), it was extremely well-attended, with a dynamic audience that was highly engaged in the discussion. Dive into Eric’s insightful blog and uncover the ultimate takeaway from his impactful presentation here.
By Ashlee Heath
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