Recently nine pharmacists from across the country were charged for their part in a $12.1M health care fraud scheme. The pharmacists allegedly took money for prescription medications that were neither purchased nor dispensed. The indictments further allege that the defendants billed Medicare and Medicaid for medications that were often medically unnecessary and for some medications that were purportedly dispensed to
Tag: fraud week
It's easy to get distracted by new developments in the fight against healthcare fraud. New services. New providers. Relaxation of rules. The COVID-19 pandemic has quickly revolutionized the healthcare landscape. For instance, the government made sweeping regulatory changes to accommodate a surge in patients. Healthcare delivery and payment organizations, commercial
Bribery and corruption continue to plague governments and organizations around the world. Brazil’s Operation Car Wash, the 1MDB scandal in Malaysia, the FIFA bribery case and many others continue to make headlines. The prevalence of widespread, coordinated corruption and bribery is alarming and seems to continue to grow, despite ongoing sanctions and fines meant to deter these
If a cinderblock falls from the 4th floor of a building and crushes a construction worker’s foot, it’s terrible. If it lands on his head, it’s truly tragic. But the difference is sheer luck. Every employee deserves to return home safely from work. Unfortunately, accidents happen, which is why employers must carry mandatory workers’ compensation
Improper payments continue to plague the federal government, though many actions are in motion to help turn the tide. The Trump Administration’s Building a Better America: A Plan for Fiscal Responsibility, released in July 2017, emphasizes reducing improper payments, currently estimated by the Government Accountability Office (GAO) to total
Any look back at analytics in 2017 makes it clear that machine learning and artificial intelligence appear to be the ‘next big things’ that can solve just about any problem, from writing new hit songs to curing disease. Not one to buy into the hype, I became curious as to
Anyone know what's the number two form of economic crime, in terms of losses? Believe it or not, it's procurement fraud. I grew up in a small town south of “Big D” and in my neck of the woods having two first names is, well, normal. So, when Will Farrell’s character,
There are several ways to buy data, and even more companies who are willing to sell it. By annual subscription or by the drink, third-party data vendors promise they can solve your identity theft and non-compliance problems. It’s as simple as signing a contract, and letting the data tap begin
Criminal enterprises are tapping into the lucrative opioid business through creative schemes that are less likely to be identified as opioid abuse, misuse or diversion. One of the latest schemes? Auto insurance fraud. First, some background… While extensive progress has been made in establishing, improving, and mandating prescription drug monitoring
On June 22nd, the U.S. Department of Justice announced the largest Medicaid fraud bust in history. The National Health Care Fraud Takedown included 301 defendants charged, $900 million in false billings, 61 medical professionals and 29 doctors, across 36 states. In another case, investigators in New York uncovered more than