OIG Files: Fraud is Always in Fashion

October 7, 2022

We are proud to bring a new fashion of fraud your way.  You might ask yourself, what is the difference between Vintage, Antique, and Retro?  Let’s start here, vintage is something that is too old to be considered used and is often related to past pop culture, junk food or fashion trends. Antique is Mt. Dora (if you know Florida you know) – something that is really old, usually musty, dusty, and unstylish.  Finally, Retro is something that is preloved, outdated and out of style.  Retro in fashion, clothing or furniture for example, may not actually be old but references styles of the past. 

On the other hand, emerging trends brings us to the part of this discussion of how to shape the future of what will be fashionable. Our thesis as far as emerging trends in healthcare fraud, like fashion, retro is where it is at – what is old is new and often fraud schemes are recycled over and over again.  Eric Rubenstein has been writing for our OIG Files for a while and we have a series of podcasts called Healthcare Retro Fraud.  Please take some time to watch our series on YouTube and Spotify.

We are bringing a new podcast to you with a kickoff featuring the Queen of Fashion and Healthcare Fraud.  We are excited to announce her next week.

Eric has shared this week:

What is 29.6% of $843,000,000? Well over $200,000,000. This is why Qui Tams will remain a force in combating FWA. Even taking about 1/3 in legal contingency fees, the Relator will see about $140,000,000. The problem is that the pharma industry will continue to perpetuate its own vicious cycle of this behavior. It is the price of doing business. Many of these companies are under corporate integrity agreements, and many have been repeat offenders. While exclusion is not a viable option, federal monitorships, higher damages and the like are options. Do not let phrases like “thought leaders,” “speakers bureau,” and “consulting services” be replacement phrases for what they often times can be; masking the kickbacks they are paid. https://www.justice.gov/opa/pr/biogen-inc-agrees-pay-900-million-settle-allegations-related-improper-physician-payments

Lots of acronyms and lots of information is contained in the report issued by the OIG on the value the UPICs provide in combating FWA in the Medicaid space. Fortunately, we at Advize have two of the foremost authorities in the space: Matt Kochanski was the NE UPIC Director and Jaysen Eisengrein, MBA, PgC, SAC (RET) was the Western UPIC Director. They are a wealth of information on UPIC operations and the intersection of FWA prevention and proper payment integrity. We will be rolling out a series of podcasts to discuss FWA from this perspective in the coming weeks. These will be not to miss discussions, where a lot of things will be demystified. Having these two best in class experts provides a level of knowledge that is second to none.

By: Jeanmarie Loria & Eric Rubenstein

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