Category Archive: Program Integrity


coronavirus

Coronavirus Fraud

By Jon Coss, CEO

March 12, 2020

With the old expression “Never let a crisis go to waste” ringing through my head, I am not at all…

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man on hoverboard in business clothes

Hoverboard Dentist Update

By Jon Coss, CEO

February 3, 2020

Way back in October of 2017, I wrote a blogpost about an Anchorage dentist who was defrauding Medicaid by performing…

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doctor in cuffs

A $28,000 Case of the Sniffles

By Jon Coss, CEO

January 2, 2020

Imagine going to the doctor because you just can’t shake that cold before the holidays and then receiving a bill…

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piles of money

Is $56B enough to get our attention?

By Tom M., Project Manager

February 27, 2019

All Posts $56 billion in overpayments? That’s more than the entire budget for the Department of Homeland Security.  In a…

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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…

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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…

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Student Loan Fraud

Student Loan Fraud

By Jon Coss, CEO

November 16, 2017

Anyone who has recently attended college or has a family member in college likely has some familiarity with student loans….

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Buried Pentagon Report Leads to Questions for Other Government Agencies

Buried Pentagon Report Leads to Questions for Other Government Agencies

By Jon Coss, CEO

February 27, 2017

Earlier this year, four government agencies – Commerce, Health and Human Services, Energy, and the Environmental Protection Agency—received letters from…

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Managed Care Fraud

Managed Care Fraud

By Jon Coss, CEO

January 9, 2017

In a recent Texas senate hearing, it was revealed that in 2015, the state’s 22 Managed Care Organizations (MCOs) had…

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Pondera’s High Potential Leader: Amanda Huston

Pondera’s High Potential Leader: Amanda Huston

By Amanda H., Chief Customer Officer

July 5, 2016

Established in 1636, Harvard University is the United States’ oldest institution of higher learning and one of the world’s most…

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Provider Screening and Program Integrity in Medicaid Managed Care

Provider Screening and Program Integrity in Medicaid Managed Care

By Jon Coss, CEO

June 13, 2016

Medicaid expenditures have nearly doubled over the last decade [1] and states have increasingly looked to a capitated reimbursement model…

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The Internet Changes Everything

The Internet Changes Everything

By Jon Coss, CEO

April 22, 2016

Way back in 2006, I read an article in the Harvard Business Review that described how the Internet had changed…

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The Problem With Knowing What You Know

The Problem With Knowing What You Know

By Jon Coss, CEO

March 10, 2016

I bet you cna’t bvleiee taht you can uesdtannrd waht you are rdnaieg. Unisg the icndeblire pweor of the hmuan…

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New Age of Identity Theft Problems

New Age of Identity Theft Problems

By Jon Coss, CEO

March 2, 2016

Remember back to last year when the IRS announced that cyber thieves stole personal data from 100,000 taxpayers? This sophisticated…

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Implementing a permanent economic stimulus package

Implementing a permanent economic stimulus package

By Jon Coss, CEO

February 29, 2016

In 2009, congress enacted the American Recovery and Reinvestment Act (ARRA), also known as the Stimulus, to bolster the economy…

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