This is good to see some progress being made. Technology will eventually help recognize some of these patterns too with running reports and queries to look for items that fall outside the normal realms. One example in this article shows one doctor making $6 million on hemorrhoid surgeries. The article continues to go on to state that one case of removing 10 was impossible, so again technology will help guide law officials into the areas to where investigations should begin.
Medicare Federal Investigators Getting Algorithms to Analyze And Find Fraud-Good Move as Contractors Efforts Are Weak With Risking Loss Of Transaction Revenue
In addition we now have the most wanted list to bring an awareness around with visuals.
One other area I think that can use some analysis too are the flawed listings on the web with doctors as crooks mine the web too. When it comes to finding fraud the FBI and DOJ are pretty much on their own as there’s not much help coming from Medicare contractors as transaction fees apply on both good and fraudulent claims so one end of an insurance contractor makes money on the other end so why cut the amount of claims going through. Anyway I suggest a major clean up here too so mining the web doesn’t lead to more crime with finding NPI numbers on dead doctors and so on. BD
Dead Doctors and Inaccurate MD Listings On the Web Can Be a Real Hunting Ground of Information to Mine For Crooks Relative to Fraudulent Medical Billing
MIAMI – Federal authorities charged more than 100 doctors, nurses and physical therapists in nine cities with Medicare fraud Thursday, part of a massive nationwide bust that snared more suspects than any other in history.
More than 700 law enforcement agents fanned out to arrest dozens of people accused of illegally billing Medicare more than $225 million. The arrests are the latest in a string of major busts in the past two years as authorities have struggled to pare the fraud that's believed to cost the government between $60 billion and $90 billion each year. Stopping Medicare's budget from hemorrhaging that money will be key to paying for President Barack Obama's health care overhaul.
A Brooklyn, N.Y., proctologist was charged with billing $6.5 million for hemorrhoid removals, most of which he never performed. Dr. Boris Sachakov claimed he performed 10 hemorrhoid removals on one patient, which authorities said is not possible. An employee who answered at Sachakov's office declined comment Thursday.
Sachakov had been arrested last year on charges related to a separate scam. Sachokov denied the charges.
Authorities also busted three physical therapy clinics in Brooklyn, run by an organized network of Russian immigrants accused of paying recruiters to find elderly patients so they could bill for nearly $57 million in physical therapy that amounted to little more than back rubs, according to the indictment.