Feds use data analytics to detect and investigate Medicare fraud

There have been countless stories in the news about how the federal government has gone about combating Medicare fraud. Still, every year the battle rages on.

Between 2012 and 2014, the Office of the Inspector General’s investigations have resulted in $14.8 billion in investigative receivables (dollars ordered or agreed to be paid to government programs as a result of criminal, civil, or administrative judgments or settlements); 2,709 criminal actions; 1,172 civil actions; and 10,363 program exclusions.

Gary Cantrell, Deputy Inspector General for Investigations for the Office of Inspector General, U.S. Department of Health and Human Services, recently detailed those numbers during testimony before the House Ways and Means Subcommittee on Oversight Hearing.

If you have wondered how regulators have gone about detecting fraud, Cantrell does a good job of explaining how his office has become a front-runner in the use of data analytics to detect and investigate Medicare fraud.

“Data-driven efforts are key to staying ahead of the evolving Medicare fraud schemes we uncover, which can involve complex criminal networks and too often cause patient harm in addition to financial loss,†he told committee members.

Click below to hear his testimony.

South Florida is the epicenter of healthcare fraud and abuse. Federal regulators have targeted the area as one of a just a handful of cities around the U.S. that are home to a dedicated Medicare Fraud Strike Task Force.

At the Health Law Offices of Anthony C. Vitale, our team is experienced in government investigations and regulatory compliance matters. We regularly defend clients in civil and criminal matters in federal and state jurisdictions across the U.S.

We can conduct internal investigations to find and correct problems even before the government gets involved.