The first Medicaid director I worked for always said, “Anecdotes trump data, but data plus anecdotes will win every time.” When you go to trail, you need the data and the anecdotes to support your position.

Anecdotes trump data, but data plus anecdotes will win every time.

If you’re prosecuting a healthcare fraud criminal case, you must show that there was intent to defraud. The defendant will probably claim that he or she just made an honest mistake, so you need to be able to show a consistent pattern of abuse. You need to show that the defendant’s practices were very different from his peers. You may be able to use a map that shows that it was impossible for a provider to have been to all of the places he billed for on single day. You want to identify victims of the fraud, who can testify how they were harmed.

When you’re defending a healthcare fraud case, you want to show that your client was doing what he thought was right. You want to demonstrate that the billing guidelines were not clear, which caused him to make the same mistake many other people make. You want to show that your client’s activities look like his peers, if his peers are identified correctly (for example, you wouldn’t want to compare a pediatric dentist to a general practice dentist). You want to be able to find the weaknesses in the prosecution’s case.

No matter which side you’re on, you’ll want an expert who knows theory and case histories. More importantly, you need somebody who has practical experience identifying and investigating fraud. Most importantly, you need somebody who can communicate the results visually and in written and oral testimony.

My first deposition was in the early 1990s, when I worked for a Medicaid program. I had prepared a complex statistical analysis to show whether our rate setting methods were fair. I was the only one on staff who understood the methodology, so I was asked to testify. I spent hours with our lawyers explaining advanced statistics in a way that they could understand. When I was deposed, I was happy to find that our lawyers had asked much harder questions than the opposing lawyers. I guess they hadn’t hired a statistician to help them.

My website demonstrates my knowledge of healthcare fraud cases and theory, as well as my communication skills. You can see that I’m a popular speaker and a recognized expert in healthcare fraud. I’ve also got over a dozen years of practical experience in healthcare financing. I have a Masters of Public Affairs from one of the top three programs in the country, and I’m an associate member of the Association for Certified Fraud Examiners.

I’m available to:

• Educate counsel about intricacies of fraud detection.
• Evaluate cases to identify hidden strengths or weaknesses.
• Assist in case development.
• Provide written statements.
• Prepare demonstrative evidence including diagrams, maps, graphs and charts.
• Testify at a deposition or trial.

Call Robin Mathias at 707-636-0418 or