The recent uptick in fraud audits, denials and revocations may seem unusual, but it is not particularly new. One former Centers for Medicare & Medicaid Services employee said he has seen it before — in the late 1990s.
“I worked for CMS on the heels of Operation Restore Trust, where I saw the current intermediary pattern of deceit and basically dysfunction evolve,” explained Michael McGowan, a former CMS Region IX OASIS…
HOW TO SPOT A “RED FLAG” (THE BEHAVIORAL AUDIT)
Keep an eye out for these behavioral shifts in your staff:
Refusal to take leave: Afraid someone will find their “adjustments.”
Unexplained wealth: Buying luxury items that don’t match their known salary.
Working odd hours: Preferring to work alone late at night when no one is watching the system.
“Gatekeeper” behavior: Becoming overly defensive or angry when someone asks to see their records.