May 2017

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Medicaid Fraud

The Medicaid Fraud Control Units report was just released. Here are a few highlights:

  1. 1,564 convictions (slightly up from 1,557 the year before).
  2. Almost $1.9 billion in recoveries. The total cost of recovery was “$259 million in State and Federal Funds” making it “an average of over $7 for every dollar spent.”
  3. The provider type with the most convictions was “PCS Attendant, PCS Agency, or other Home Care Aide” with 552.
    1. The next provider type was “Nurse (LPN, RN, or other licensed), PA, or NP) with 171.
    2. “Nurse Aid” came after that with 153.
    3. Followed by “Family Practice Physician” with 57.
    4. And coming in last was “Home Health Agency” with 48.  
  4. 74% of the convictions involved fraud, 26% involved abuse or neglect.
  5. Pharmaceutical manufacturers accounted for “almost half of the civil settlements and judgments.”
  6. There were 998 civil settlements/judgments, the highest number in the last five years.

That sums up the most interesting data from this year’s report. The one that stands out the most to me is that pharmaceutical manufacturers accounted for “almost half of the civil settlements and judgments.” The report provides some insight:

Pharmaceutical manufacturer settlements typically relate to the marketing of prescription drugs. An additional 70 settlements and judgments involved laboratories, 67 involved medical device manufacturers, and 57 involved retail and wholesale pharmacies.  

The context is helpful, especially knowing that most of the settlements/judgments were because of marketing related issues. As always, if you have specific questions about compliance, data availability, the nuances of a particular source, or the best place to find the data you’re looking for, please don’t hesitate to reach out to me directly at or to call me at 800-780-5901, Extension 103.  

Image result for FarewellSeveral years ago, a couple of associates from other lives came to me and asked if I was interested in starting a new compliance data and CVO business.  I had retired…again and was busy doing volunteer work, hanging with my wife, children, and grandchildren and doing what most retirees are doing. We had long chats about the underserved full healthcare provider data world and having worked in Investigations, Event Security, background screening and medical provider data in past lives, I felt the idea of building a company that was nimble, more accurate, with great analytics over the top was indeed intriguing.

I saw a plan for building using cloud based systems, screamingly fast technology with security next to none in this space.  Deep and wide data beyond anything I’d ever seen before.  All Federal, State Exclusion, and board data plus CVO services with all relevant data at a great price was a reality!  No holes, no delays, no excuses.  What we had was a robust plan for a real continuous monitoring product line of all data familie! Bam! Our solution was more than just putting lipstick on a pig. It was a real solution.

Having been up close and personal with another similar provider, I quickly saw that Questin Francis, who would become the CTO of this new enterprise, had cracked the code in so many ways.  And the old song and dance of older, better, more data was washed away in an instant.  I was in.

What a great ride.  In the intervening years I became a part of a great family of professionals; partnered with great customers and vertical partners and a healthy work culture. TyphoonDATA offers a better way for their employees, and their customers.  It aligns with the Health in Healthcare.

The baby was born, began to crawl and eventually walked.  Today, it is running… So it’s back to retirement I go.  I’m ready to turn the page.  TyphoonDATA is successfully serving  the healthcare compliance and consumer reporting industries.

Thanks to Questin and Dan for their partnership, the investors that believed in us, and the great employees of TyphoonDATA.

Vaya con Dios…

Until we meet again along the road.