How can investigators predict healthcare fraud?

Predictive modeling is a term that has been used a great deal lately in the context of healthcare fraud. In a nutshell, predictive modeling is the area of data mining concerned with forecasting probabilities and trends. Here in South Florida, many of us are familiar with its use through the forecasting of hurricanes. In the […]

Feds step-up crackdown on fraudulent billing for compounded meds

The recent indictment of a St. Petersburg physician who was charged with receiving illegal kickbacks for writing prescriptions for compounded medications serves to further highlight the federal government’s increased level of scrutiny over the industry. The facts of the latest case are as follows: Dr. Anthony Baldizzi was charged on June 23 with one count […]

Feds target healthcare fraud by looking for outliers

Last week, the U.S. Department of Justice announced the largest healthcare fraud takedown in its history. Approximately 300 defendants in 36 federal districts, including South Florida, were charged with engaging in fraudulent billings to the tune of more than $900 million. Charges included: conspiracy to commit healthcare fraud, violations of the anti-kickback statutes, money laundering […]

Genetic testing latest scam targeting Tricare

The Tricare program is once again the target of fraudulent claims. The health insurance program for members of the U.S. military, their family and retired military, has been bilked millions of dollars for unnecessary genetic tests and drug screening, according to media reports. The latest alleged Tricare scam goes something like this: Labs set up […]

Report: HHS OIG fraud recoveries on the rise

The Department of Health and Human Services Office of the Inspector General recently released its semi-annual Report to Congress outlining its anti-fraud activities. The report highlights OIG’s accomplishments for the six-month period ending March 31, 2016. The agency noted that during that period it reported expected recoveries of more than $2.77 billion consisting of nearly […]

Healthcare Fraud and Abuse Crackdown Not Slowing as Evidenced by Recent Cases

The federal government has been busy since the beginning of the year announcing arrests, convictions and settlements relating to healthcare fraud and abuse. The activities relate to violations of the Stark Law, anti-kickback law and federal False Claims Act, and there appears to be no end in sight. Whether it’s home health, transportation, durable medical […]

Government recovers $1.9 billion in healthcare fraud judgments and settlements in FY 2015

A newly released report by the Health Care Fraud and Abuse Control Program (HCFAC) shows that the federal government won or negotiated more than $1.9 billion in healthcare fraud judgments and settlements in fiscal year 2015. As a result of these efforts, as well as those of preceding years, in fiscal year 2015, approximately $2.4 […]

Lessons learned from whistleblower FCA case against cancer treatment company

Earlier this month, the U.S. Department of Justice announced that 21st Century Oncology and its wholly owned subsidiary, South Florida Radiation Oncology LLC, agreed to settle False Claims Act allegations relating to billing for procedures that were medically unnecessary. Specifically, the Fort Myers, Florida-based company was alleged to have billed for performing the Gamma function […]

GAO: Smart cards not a viable weapon in battle against healthcare fraud

There’s been a lot of debate in the last few years over the value of smart cards in the war on healthcare fraud. Some have argued that their use would go a long way toward preventing beneficiaries’ IDs from being used to perpetuate fraud in the healthcare system. Others have suggested that their use would […]

Social media posts can be used to detect healthcare fraud

In George Orwell’s novel Nineteen Eighty-Four, citizens of Oceania, a totalitarian state, are under surveillance at all times and constantly reminded that Big Brother is watching them. Today, with the advancement of digital technologies – from cameras on the street and in stores, to cookies gathered from the Internet – most of us are being watched […]

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It is not intended as professional advice and should not be construed as such.