Conceptual Analytics Assists with Department of Justice Request

Client Challenge

The government requested that the client look into potential violations of the Stark Law – a regulation which prohibits physician referrals of designated health services (“DHS”) for Medicare and Medicaid patients if the physician (or an immediate family member) has a financial relationship with that entity. Specifically, the DOJ was interested in claims that the hospital had accepted free testing materials from a specific lab, with the understanding the hospital’s tests and analyses would subsequently be performed by that lab.

The client suspected that a recently terminated employee had made the accusation and believed that only a few individuals had knowledge of the hospital’s relationship with the lab. The client’s data retention policy mandated that all employee email and e-files must be archived, so they were able to provide Consilio with the terminated employee’s email and all data from his laptop.

Consilio Response

Consilio’s Analyst ingested the data into the Riskcovery platform, which was kept at the client site throughout the engagement, in order to maintain compliance with HIPAA regulations. After ingestion, the Analyst used text from the original Civil Investigative Demand, along with other conceptual samples, to create a custom taxonomy.

The Riskcovery platform identified documents and email which were conceptually similar to the samples in the taxonomy. These documents were sorted to identify materials which were most conceptually similar

The second highest ranking document was an email from the suspected employee to the lab in question, detailing an agreement to send all analyses to the lab if testing materials were provided free of charge.

Collected data was ingested into multiple review databases based in three data centers for review teams working concurrently. Project approach and statuses were Additionally, the Analyst determined that during the last three months of employment, the suspected employee had sent over 3,000 emails to a personal email account. These emails contained information not only about the hospital’s agreements with various labs, pharmaceutical companies and partners – they also included information about specific patients. This was a clear violation of HIPAA regulations by the employee, and the client requested a complete export of all data for further review.

Results Achieved

Given Consilio’s findings, the client and counsel were able to justify the need for further investigation of all of the custodians that Riskcovery identified. Additionally, by using Riskcovery, the Analyst was able to assist the client in its response to the DOJ and provide a roadmap for necessary action items for counsel.

Company Profile

Regional Medical Center

Services Utilized