Episodes
10
Latest episode
Aug 2026
Language
EN-US
Former HHS-OIG Senior Special Agent Eric Rubenstein discusses historical fraud cases that either he or others investigated and how the "circus does not change, only the clowns do." In these podcasts, Eric and his guest discuss how the facts of the case have significance to today’s fraud schemes.
Eric and Matt discuss a recent $46m global resolution involving the cornucopia of kickbacks: lavish gifts, cash and prizes. The pharmaceutical manufacturer resolved the matter and was not excluded. Like winning the Showcase Showdown, and getting a 4 day, 3 night stat at the NY Algonquin Hotel, sometimes fraud does pay.
Eric, Wade and Matt discuss recent work being done by UPICS as it relates to plans and audits being conducted by the UPICS of plans. This is bit of a shift from what we know the UPICS to do, but is not uncommon.
Eric and matt discuss some of the top moments in history that changed or affected the healthcare payer and payment industry. While this is only the tip of the iceberg on this topic, we look forward to keeping this discussion moving along.
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.
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.
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.
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.
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.
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?
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.
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Valerie Hail
Mediaite
PodcastOne
Russ Mathews
