FraudCast


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.

Pondera’s Founding

Pondera’s Founding

September 12, 2016

I am often asked what motivated me to start Pondera. So… Here goes. In 2011, after my previous company was acquired, a good friend working at Google asked me to visit their Mountain View campus. He was interested in learning how to embed Google products in large government programs like Medicaid, Unemployment Insurance, and eligibility […]

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Why It’s Important To Be Nimble When Fighting Fraud

Why It’s Important To Be Nimble When Fighting Fraud

September 7, 2016

Fighting fraud is an interesting challenge. When an organization shuts down a fraud scheme, bad actors don’t suddenly become good citizens. Rather, they evolve. They evolve by designing and testing new methods that, when they succeed, are exploited until they too are detected and shut down. In fact, many of the more enterprising fraudsters proactively […]

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RFPs: The Devil is in the Details

RFPs: The Devil is in the Details

August 17, 2016

As a company that works with government clients, we spend a tremendous amount of time and money responding to Requests for Proposals (RFPs). We understand that governments use RFPs to ensure competitive bidding processes and to articulate their requirements. However, the process still causes enough angst for prospective bidders that, ironically, it often actually limits […]

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Fraud, Waste, and Abuse Standards

Fraud, Waste, and Abuse Standards

August 10, 2016

One of my colleagues recently returned from a conference on government program integrity with an interesting anecdote. He recounted a vendor presentation where the speaker was touting a 52% accuracy rate in their fraud lead generation system. So… nearly half of the system’s leads generated false positives. Not so sure I’d brag about that. High […]

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The Most Important System Feature

The Most Important System Feature

August 3, 2016

I believe that simple things can make a big difference. This week, for example, I went through self-checkout at a local grocery store and the keypad gave me the options of “debit card” or “all other tenders” to complete my transaction. “All other tenders”—who talks like that? No doubt there was a group of people […]

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Ugly Case of Health Care Fraud

Ugly Case of Health Care Fraud

July 27, 2016

A few weeks ago, I published a blog post titled “Money Obtained Fraudulently is Rarely Used for Good Purposes”. In it, I made the argument that government fraud is a serious, and at times very ugly problem. Now I no longer have to make that argument because the United States Justice Department is making the […]

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The False Positive Problem

The False Positive Problem

July 19, 2016

Last year, 60 Minutes did a segment on the impact of errors in the Social Security Administration’s Master Death File—a database that stores dates of death for Americans. The system stores 86 million records, and despite all best efforts, it still has some issues. 60 Minutes pointed out that errors in the system contribute to […]

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Pondera’s High Potential Leader: Amanda Huston

Pondera’s High Potential Leader: Amanda Huston

July 5, 2016

Established in 1636, Harvard University is the United States’ oldest institution of higher learning and one of the world’s most prestigious universities. A couple of weeks ago, I had the remarkable opportunity to participate in the Harvard Business School Executive Education Program for High Potential Leaders. To step foot on this amazing campus filled with […]

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Provider Screening and Program Integrity in Medicaid Managed Care

Provider Screening and Program Integrity in Medicaid Managed Care

June 13, 2016

Medicaid expenditures have nearly doubled over the last decade [1] and states have increasingly looked to a capitated reimbursement model utilizing managed care organizations (MCO) to ensure continued access to quality health care services. The Centers for Medicare and Medicaid Services (CMS) estimate that roughly 80% of all Medicaid recipients currently receive healthcare services via […]

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Learning from Antivirus Software

Learning from Antivirus Software

May 27, 2016

Almost everyone is familiar with antivirus software. Not everyone is familiar with how it works though. Even fewer have examined how we can apply the way antivirus software works to combat fraud. I believe that there are important lessons here which can improve our approach to fraud detection and prevention. At a high level, antivirus […]

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