Skyrocketing spending on skin substitutes: The investigative process

Federal inspectors are getting better at tracking down real time data for Medicare and other programs. But the reality of investigating and auditing involves time spent waiting for a situation to develop and for data to become available as evidence. David Tawes, MA, regional inspector general in the Baltimore, Maryland, HHS-OIG Office of Evaluation and Inspections, describes that investigative process.

Medical Economics: How does the investigative process evolve over time when regulators begin noticing trends in data?

David Tawes, MA: That is something that we face all the time, especially in traditional Medicare, where bills are required to be paid, like, within a certain amount of time. So in those cases, we have to wait for claims data to come in, notice anomalies in the claims data, and then hopefully make recommendations to Medicare or Medicaid to make changes. It's, timely process and a time consuming process, and we've gotten much better at accessing data in real time. But there's always going to be a lag in between when something pops up and when the enforcement can catch up to hopefully trying to fix it.