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

2. 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

3. 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.

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

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

6. 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

7. 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