Terry Gerton You’ve done some looking into a data set that the DOGE team inside the Health and Human Services agency released. It described it as the largest Medicaid data set in department history. From your legal perspective, what was different about this release compared to prior transparency or fraud prevention efforts?
John Barry Well, there’s a couple things. This is the first time that the Department of Health and Human Services has ever released provider-level Medicaid data to the public. Previously, there were very limited ways to access Medicaid provider-level data, meaning data that you could look at specific providers and what they were billing, but that was required often institutional access and cost money. This is the first time that this has ever been available to the public, and specifically, a data set released to the public for the public to look at and try to find…
MANAGEMENT & CULTURE (THE “TONE AT THE TOP”)
Fraud thrives in “sloppy” environments where leadership ignores the rules.
- The Fraud Triangle: For fraud to occur, three elements must be present: Pressure (the need for money), Rationalization (thinking “I deserve this”), and Opportunity (weak controls). You can only control the Opportunity.
- Whistleblower Hotline: Provide an anonymous way for staff to report “odd behavior.” Most internal frauds are caught via tips, not audits.
- Background Checks: Conduct credit and criminal record checks for all employees in financial or data-sensitive roles.
- Annual Ethics Training: Make sure every staff member knows that the company has a Zero Tolerance policy toward “borrowing” from petty cash or fudging overtime.