New Record for Healthcare Fraud: $163 Million
By Mike Betron, Infoglide Software Director of Marketing
Last night the largest Medicare fraud operation yet discovered was in the headlines:
A vast network of Armenian gangsters and their associates used phantom health care clinics and other means to try to cheat Medicare out of $163 million, the largest fraud by one criminal enterprise in the program’s history, U.S. authorities said Wednesday. Federal prosecutors in New York and elsewhere charged 73 people. Most of the defendants were captured during raids Wednesday morning in New York City and Los Angeles, but there also were arrests in New Mexico, Georgia and Ohio.
The latest installment in this ongoing saga includes billing for unnecessary and never performed procedures, stolen identities, and phony clinics:
The defendants in the New York case also had stolen the identities of doctors and set up 118 phantom clinics in 25 states, authorities said. The names were used to submit fake bills for care that was never given, they said.
How can those responsible for payments not detect phony clinics? Many sources of public and private information are available to validate their existence, yet apparently systems to perform this function are not in place 45 years after Medicare was created. As Mike Shultz said here in a June post:
Honest suppliers stand by helplessly as competitors cash in on the bonanza. One such supplier wrote in a guest post about how current detection methods are inadequate and how the problem can be attacked with the right technology.
Several months ago I asked the question, that if “every day, identity resolution software screens every airline passenger on every U.S. domestic flight to prevent known criminals and terrorists from boarding airplanes without being detected,” then “could the same technology be used to make the whole Medicare and Medicaid infrastructure more proactive in preventing fraud?” The answer is still “yes.”
