Category Archive: Program Integrity


Student Loan Fraud

Student Loan Fraud

November 16, 2017

Anyone who has recently attended college or has a family member in college likely has some familiarity with student loans. In fact, 40 million Americans currently have student loans totaling an astounding $1.2 trillion dollars. Many of those who have applied for loans have been victimized by methods such as “advanced fee scams” that promise […]

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Buried Pentagon Report Leads to Questions for Other Government Agencies

Buried Pentagon Report Leads to Questions for Other Government Agencies

February 27, 2017

Earlier this year, four government agencies – Commerce, Health and Human Services, Energy, and the Environmental Protection Agency—received letters from congress directing them to provide documents and comments detailing their efforts to “identify waste and… to achieve budget savings in the next five years.” The letter referenced a report from the Pentagon that identified a […]

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Managed Care Fraud

Managed Care Fraud

January 9, 2017

In a recent Texas senate hearing, it was revealed that in 2015, the state’s 22 Managed Care Organizations (MCOs) had recovered only $2.5 million of fraudulent payments out of $12.5 billion in claims. That’s about two-hundredths of a percent. Not one of the MCOs recovered even 1% of payments and most reported less than $20,000 […]

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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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The Internet Changes Everything

The Internet Changes Everything

April 22, 2016

Way back in 2006, I read an article in the Harvard Business Review that described how the Internet had changed the sales profession. One key observation dealt with the “de-coupling” of the sales cycle from the buying cycle. Prior to the Internet, buyers had to contact vendors for information on their products. Today, buyers do […]

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The Problem With Knowing What You Know

The Problem With Knowing What You Know

March 10, 2016

I bet you cna’t bvleiee taht you can uesdtannrd waht you are rdnaieg. Unisg the icndeblire pweor of the hmuan mnid, aocdcrnig to rseecrah at Cmabrigde Uinervtisy, it dseno’t mttaer in waht oderr the lterets in a wrod are, the olny irpoamtnt tihng is taht the frsit and lsat ltteer be in the rhgit pclae. […]

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New Age of Identity Theft Problems

New Age of Identity Theft Problems

March 2, 2016

Remember back to last year when the IRS announced that cyber thieves stole personal data from 100,000 taxpayers? This sophisticated scheme accumulated personal data from other sites and used it to answer identity validation questions on the IRS web site to gain access to taxpayer accounts. The 100,000 taxpayers affected? The IRS revised that number […]

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Implementing a permanent economic stimulus package

Implementing a permanent economic stimulus package

February 29, 2016

In 2009, congress enacted the American Recovery and Reinvestment Act (ARRA), also known as the Stimulus, to bolster the economy and help America recover from the Great Recession. The idea was that various tax credits, business incentives, and public works projects would stimulate the economy while also improving the nation’s infrastructure. While arguments continue over […]

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