Special Investigations Units: Best Practices and Emerging Considerations
November 10, 2015
Senior Program Director Jala Attia answers a few questions on topics her team addressed in their SIU Best Practices panel at NHCAA’s Annual Training Conference.
Question: Where are some often over-looked areas where a Special Investigations Unit (SIU) can improve fraud, waste and abuse (FWA) investigations?
Jala Attia: One overlooked area is taking full advantage of no-cost information when investigating an allegation. As investigators, we generally favor a few sources of information and rely primarily on those. But there are a variety of other sources that can help in FWA investigations. In addition to typically available public records data, the OIG and State Exclusion lists, PACER (Public Access to Court Records) or even Guidestar.org can prove powerful. It’s not enough to simply analyze claims data – you want to create a full picture of behavior and the more information you can compile, the better informed you will be. For example, Guidestar.org allows you to review and analyze tax returns for non-profit organizations and to review reported income.
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Jala Attia, Senior Program Director, General Dynamics Health Solutions
Vendors should absolutely think like fraudsters, be imaginative and search for ways that providers could possibly target their clients."
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