OIG Files: Open (Enrollment) Season on Fraud

OIG Files: Open (Enrollment) Season on Fraud

Open enrollment will be upon us in the coming month.  With it will come a slew of fraud complaints as it relates to managed care enrollment.  Brokers work to enroll eligible members into plans that are supposed to be the best suited for the member. ...
Come Fly With Me: National Harbor

Come Fly With Me: National Harbor

My Thursday started in Philly then Maryland, DC, Atlanta for a quick layover and then ended in Orlando.  What a day! The highlight of that 5 city day was going back to Maryland again this week but only this time, the area was Fort Washington and some of the...
OIG Files: A Little Silver Lining

OIG Files: A Little Silver Lining

A phrase that does not often come up is “medical loss ratio,” or MLR.  As an OIG Agent, I spent very little time looking at the OIG Workplan (I’ve blogged and spoken about how OIG Agents follow the current frauds, and how the plan is very much used to direct the work...
Don’t Ride the Carousel

Don’t Ride the Carousel

In some of my recent posts, I have mentioned the term “carouselling,” as it pertains to the recycling of diabetic testing supplies.  I have had several people inquire about this term and how the scheme works. Carouselling Is the purchasing and reselling of...