Welcome to the Pondera FraudCast, where we post information on fraud trends, lessons learned from client engagements, and observations from our investigators in the field. We hope you’ll check back often to stay current with our efforts to combat fraud, waste, and abuse in large government programs.

Striking a balance between speed and accuracy; SNAP PI is like a biathlon!

By Amanda H., Chief Customer Officer

March 14, 2019

Take your time, but hurry up. How many of us have heard that old cliché before? If you are in the business of SNAP program integrity, the answer is ALL THE TIME. SNAP PI teams have the daunting task of delivering fraud prevention safety nets and fraud detection and investigation support that does not slow […]

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piles of money

Is $56B enough to get our attention?

By Tom M., Project Manager

February 27, 2019

$56 billion in overpayments? That’s more than the entire budget for the Department of Homeland Security.  In a March 2017 report (GAO-17-277) by the U.S. Government Accountability Office, it was estimated that the 2016 improper payment rate was $56 billion, or 9.8 percent of all Medicaid expenditures of $576 billion.  Those overpayments represent a combination […]

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The Secret Ingredient in Customer Success (Hint: It’s not ketchup!)

By Dr. Shehab P., Customer Value Director

February 13, 2019

If you have something to sell, your success is directly tied to your understanding about what your customer actually wants. So how do you know what your customer wants when people don’t always know what they want? Interestingly, this is even true in online dating. In his book, Modern Romance: An Investigation, author Aziz Ansari […]

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physician exclusion

Trends in Physician Exclusion: Characteristics for Consideration to Complement Analyses

By Amy K., Training & Development Manager

January 16, 2019

What is predictive profiling? How does predictive profiling help the healthcare industry? How do statistics and identifying traits inform decision-making about healthcare providers? Predictive profiling is often criticized for its use by law enforcement as potentially being biased or perpetuating inequality.  However, I have spent the last 24 years investigating financial fraud with data analytics.  […]

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Elder Financial Fraud

By Mark L., Director of Intelligence

January 9, 2019

For most of us, receiving a phone call or email advising we had just won the lottery likely would be followed by a quick hang-up, deletion, or not-too-subtle reply of “bug off”.  The attempted scam would be obvious, and we would move on with our daily lives without any further thought of missing out on […]

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Phishing for Fishing Gear

By Caryn O., Director of Marketing

January 2, 2019

Whew! The holidays are over, and I wore out my account to find the perfect gifts.  It seemed I received a shipment update email every day. In order to keep track of the dozen gifts I had ordered, I quickly glanced at each email to see if any action was required. A week before […]

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Medical Record Healthcare

The Health Impact of Fraud

By David D., Account Executive

December 21, 2018

As the PI Director at an MCO and as the VP at the South-Central US ZPIC, I saw the impact that fraud has on the bottom line every day.  Healthcare fraud costs the government and private insurance billions of dollars annually.  The system is built on trust, as consumers/patients, we trust that the physician, hospital, […]

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Learning analytics identify human technology

Analytics are more than Numbers and Stats – It’s About People by Tammy Marple, VP – Special Investigations Unit

by Tammy M., Vice President SIU

August 7, 2018

During my time as a fraud analyst, I realized that my work was so much more than just numbers and statistics. I worked in State Government for many years and a few years ago, my manager asked me to conduct a study on Opioids. I lived that assignment for 18 months. After the Opioid study […]

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Cigarette Fraud

By Jon Coss, CEO

May 14, 2018

Last week we wrote about charges being brought against a group of alleged fraudsters in California that were trucking thousands of cans and bottles into California to collect the state’s recycling refunds. This week, just so no one feels left out, we’re bringing you a story from the East Coast that deals with cigarette fraud. […]

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How to Steal $80 million Five Cents at a Time

By Jon Coss, CEO

May 10, 2018

Last week, in the realm of “are there any government programs fraudsters won’t steal from”, California officials announced charges against five people who were ripping off the state’s recycling program. Four defendants are accused of accepting recyclable cans from other states, faking the paperwork, and then billing the state for refunds on the 5- or […]

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