Medicaid program integrity, in simple terms, is a program that ensures that the funds allocated for Medicaid are used appropriately, that patients receive the care they deserve and that resources aren’t mishandled. But consider this staggering fact: In 2020, the Centers for Medicare and Medicaid Services (CMS) reported that Medicaid
On June 22nd, the U.S. Department of Justice announced the largest Medicaid fraud bust in history. The National Health Care Fraud Takedown included 301 defendants charged, $900 million in false billings, 61 medical professionals and 29 doctors, across 36 states. In another case, investigators in New York uncovered more than
According to Time Magazine, the next Ebola outbreak will cost the World Bank in excess of $30 billion dollars. In 2014, America spent in excess of $1.16 million dollars to treat two victims of the dreaded disease. While Ebola and other microorganisms of the deadly variety are scary creatures there
On a cold and wet December morning in 2008, at approximately 1:30 AM, I pulled into the parking lot of an abandoned supermarket in Arlington, TX. With sleet pelleting my windshield, I saw three additional sets of headlights enter into the parking lot from different directions. All three cars converged
All of us are familiar with common fraud types. Insurance fraud, credit card fraud, identity theft, and tax evasion are among the most recognized areas. But, there are many other fraud types that have a big impact on our daily lives, yet receive little attention in the media and among
For most people, this time of year means celebrating cherished, personal traditions… helping those less fortunate…flocking to stores in droves…the company holiday party… For the SAS Security Intelligence team, it means identity theft…benefits fraud…unemployment insurance fraud...insider threats. Why? Because next week is International Fraud Awareness Week! And we’re celebrating by
There are times when I harken back to the classic television show M.A.S.H. For those of you too young to remember, the story centered around a mobile Army surgical hospital in the midst of the conflict in the Korean peninsula. While they weren't the first people to see the patient, the unit
It's time for a fall fraud roundup. Bad deeds swirl around like so many dry leaves, and I'd like to highlight a few of them this week. It can happen anywhere, even in sports, and no, I'm not picking on those shoplifting Dallas Cowboys here. An MLS referee was suspended for workers' compensation
Another day, another scam defrauding insurers and governments. For purposes of full disclosure, the case I'm highlighting today comes from Washington's Labor and Industries (L&I), the agency where I formerly worked and headed up fraud prevention efforts, and the investigation dates back to my time there. During my time there,
Data. Google uses ours every day, and most people aren't concerned. When our government is looking over our shoulders, however, tensions rise quickly. On the one end lies the recent scandals with the National Security Agency (NSA), which is apparently spying on you, me, and Angela Merkel. On the other lies case after case
Personally, I love studies. They help put things into context, and when done well, provide an independent and hopefully unbiased view of the forces that shape our lives. They are also a great way to see government funds used in strange ways. For example, the new NIOSH (National Institute for
Watching our nation approach the "fiscal cliff", and the dire predictions if we truly drive off it like the last scene in Thelma and Louise, has sharpened my view of the potential risks that huge gaps of fraud and abuse present to all of us. One of the key lessons
