Episode 29 : Medicaid Manipulators

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Hosted by: Shannen Reyes-Aguayo & Nyleen Flores
IG: @shannensunfloweraguayo | @nyleenfloresfam

Fraud. Defendants... Shell companies. Federal crackdown.

This week on Credentialing Chronicles, Shannen & Nyleen go full investigative mode on the largest healthcare fraud takedown in U.S. history — Operation Gold Rush.

From catheters moved like burgers on a grill to braces billed for amputees, we’re exposing how Medicaid fraud has evolved into an industrialized business model. This isn’t fringe crime — it’s organized, automated, and devastating to the patients Medicaid was meant to protect.

🔥 In this episode:

• Why the OIG is now posting fraud busts on LinkedIn (and what that says about public deterrence)
• The infamous “1,000 leg braces” scheme — and how it slipped through the system
• How Operation Gold Rush raked in billions through stolen identities and shell suppliers
• What keeps DME fraud thriving (and why enforcement can’t keep up)
• The tools compliance, billing, and credentialing pros can use to stop the next scam before it starts

🧾 With $1.4B recovered and $14.6B exposed, this isn’t just a headline — it’s a wake-up call.
If you touch Medicaid oversight, healthcare billing, or credentialing, this episode proves: you’re part of the fix.

🎧 Listen now — and don’t forget to share, tag your compliance crew, and make some noise.
Fraud doesn’t hide anymore — and neither should your defenses.

#CredentialingChronicles #HealthcareFraud #OperationGoldRush #OIG #Compliance #MedicaidFraud #Credentialing #FraudPrevention

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Resources Mentioned:

Open Payments

openpaymentsdata.cms.gov

Verify your Nurses' Credentials:

https://www.nursys.com/

🔎 Verify Your Doctor’s Credentials

✔️ State-Specific Medical Board License Lookup:
Find your state’s board here:
https://www.fsmb.org/contact-a-state-medical-board/

✔️ Medicare Exclusions List (LEIE) – Check if your provider is federally excluded:
https://oig.hhs.gov/exclusions/exclusions_list.asp

✔️ Set Google Alerts on Your Doctor’s Name:
Create your own Google Alert here:
https://www.google.com/alerts

For Medical Staff Professional:

✔️ FSMB.org – Federation of State Medical Boards Physician Lookup:
https://www.fsmb.org/physician-license-lookup/

✔️ Hospital Websites:
Many hospitals have public directories listing credentialed medical staff. Look for a “Find a Doctor” or “Medical Staff Directory” page.

✔️ Set Google Alerts on Your Doctor’s Name:
Create your own Google Alert here:
https://www.google.com/alerts

🔎 Wanna know if your doctor is actually board certified?
Check for yourself right here:
👉 Verify a Plastic Surgeon

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