Zusammenfassung der Episode
In Part 2 of our SIU Roundtable, we explore how Medicare, Medicaid, and commercial payers approach fraud investigations when claims and schemes cross payer lines. Hear real-world perspectives on coordination of benefits, investigative responsibilities, communication gaps, and why collaboration matters in the fight against fraud, waste, and abuse.
In Part 2 of our SIU Roundtable, we explore how Medicare, Medicaid, and commercial payers approach fraud investigations when claims and schemes cross payer lines. Hear real-world perspectives on coordination of benefits, investigative responsibilities, communication gaps, and why collaboration matters in the fight against fraud, waste, and abuse.
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The SIU Roundtable: When Fraud Crosses Payer Lines, Part 2
GehörtIn Part 2 of our SIU Roundtable, we explore how Medicare, Medicaid, and commercial payers approach fraud investigations when claims and schemes cross payer lines. Hear real-world perspectives on coordination of benefits, investigative responsibilities, communication gaps, and why collaboration matters in the fight against fraud, waste, and abuse.
The SIU Roundtable: Vendor, Payer, and Government Perspectives, Part 1
GehörtSame mission. Different playbooks. In this episode of The F Files, we bring together investigators from vendor, payer, and government environments to compare how fraud investigations really work. From leads to outcomes, hear how perspective shapes every step. Part 2 coming soon.
S5,E4: Emerald Illusions & Pots of Gold
GehörtToo-good-to-be-true promises often hide the biggest fraud schemes. In this episode, Mandi and Daphne explore the “pot of gold” illusion in fraud, from leprechaun folklore to the real-world deception behind the Theranos scandal. The episode also features a conversation with HCFS team member Paula about HCFSElevate, the upcoming user conference in Austin, where guest speaker and whistleblower Tyler Schultz will share the story behind exposing Theranos and why investigative professionals remain essential to uncovering fraud.
S5,E3: Behind the Med Spa Curtain
GehörtFrom bloodletting and Botox to ghost doctors and falsified lab codes, this episode exposes the dark side of "wellness" clinics and concierge med spas. Join hosts Daphne Krout and Mandi Cook as they uncover firsthand accounts of risky procedures, insurance manipulation, and outright fraud. Featuring a special guest RN turned fraud fighter who shares what really happened behind closed doors.
S5, E2: Vans, Scams, and Suspicious Miles
GehörtNon-emergency transport might sound routine, but it's become a hotspot for fraud. In this episode of The F Files, hosts Daphne and Mandi dig into schemes involving falsified mileage, upcoded services, and even transport crews lacking certification. From bizarre van rides to six-figure fraud cases, they reveal how something as simple as a ride to dialysis can turn into a $6 million scam. Whether you're in SIU, compliance, or analytics, get ready to uncover red flags and sharpen your detection game.