Numbers-Numbers-Numbers Data Analytics—The Future of Government Investigations and Monitoring By: Michael F. Ruggio Nelson Mullins Riley & Scarborough LLP

Scope of Problem: DOJ recovered $4.7 billion in settlement and judgments in 2016 From 2009 to 2016 – Total recovery is $31.3 billion Only 7%-10% of actual fraud investigated

Health care Industry and Technology Everything has a technology component; Everything needs to be counted; Data Collection is critical; Data Storage is necessary for the future of health care.

Data Analytics is the Solution!!! Enables entity to track “everything” usage, waste, efficiency, etc. Maximization of provider services, etc.

Data Analytics is the Problem!! Who is watching? OIG, DOJ, AG, State Agencies Whistleblowers Competition

Increased Use of Data Analytics in Criminal HCF Cases Significant investment in data analytics resources, tools and personnel Newly formed fraud section Data Analytics Team; Supports Medicare Strike Force cities (Fraud Section and U.S. Attorneys’ Offices) HHS-OIG Consolidated Data Analytics Center (CDAC) Find investigative leads, identify trends and targets, corroborate fraud tips Access to real-time billing data Data Analytics Focus High-risk Providers Billing outliers (by geographic area, type of service, specialty/peers) Correlates providers information with payer information and with patient information

Conclusion and Take-Aways: The percentage of OIG Fraud and Abuse cases based on data analytics has increased approximately 30%-40% in the last two years; this is only the beginning. The case will generally be larger The case will be more difficult to defend The Federal and State regulatory and investigatory authorities are all investing in greater use of the technology