This is pretty hot stuff and is updated as to when the folks on the list get captured.  imageThere’s even a place on the site where you can report information about any of those listed on the “Most Wanted List” for healthcare fraud.  To report one can either fill in the form on the website or call the hotline, toll-free, 1-888-476-4453.

I did some looking around and there’s all types on this list to include some former doctors who are apparently on the run.  The site also shows their reported accomplices along with pictures.  The rap sheets vary and some are those convicted of fraud that took off and are in hiding.  There’s quite a few from Florida and California has a few too. 

Here’s one example who happens to be a registered nurse:

“Along with her co-conspirators, Susan Bendigo, who was born in the Philippines, is accused in a Federal indictment of billing Medi‑Cal, California's Medicaid program, for $17.1 million, collecting $10 million, about half of which came from the claims she submitted for services she provided with unlicensed staff.

A registered nurse, Bendigo was director of nursing for a company that provided nurses for home health agencies. Investigators say that from May 2004 through May 2007, she sent unlicensed nurses to treat patients under Medi‑Cal, even though she knew that Medi‑Cal required licensed nurses to perform the work.”


Fraud costs everyone money and this latest effort certainly can’t hurt at all.  Medicare has been such a huge target for fraud and with combined efforts through new technology from HHS to be able to analyze claims hopefully this will make a dent as the law enforcement agencies have made the biggest dent in this area.  Contractors don’t really have much incentive to fight fraud as they have subsidiaries that make profits from other areas of their entire operation.  In one such area the Office of the Inspector General found some big interest being made by holding Medicare funds over 45 days. 

Insurers Made $450 Million with Interest Income by Holding Medicare Funds for Around 46 Days Before Releasing Payment

Finally some business intelligence is coming to CMS and other areas of HHS, which has been longer needed.  This will help identify some of the claims that perhaps fall out of the normal parameters and cue them for a second look and law enforcement agencies will all have access as well and it will enrich the information they need to work their cases too with some algorithms to identify fraud.  BD

Medicare Federal Investigators Getting Algorithms to Analyze And Find Fraud-Good Move as Contractors Efforts Are Weak With Risking Loss Of Transaction Revenue

Office of Inspector General to Monitor Upgrade of CMS Computer and Data Systems and Stimulus Incentives for EHRs

WASHINGTON – Taking a cue from the FBI, the Health and Human Services Department has released an online list of its "Most Wanted" fugitives charged with committing healthcare fraud.

The Most Wanted Fugitives List is the government's latest attempt to focus public attention on individuals sought by authorities on charges of bilking federal healthcare programs and fleeing with the money.

The list includes photos and profiles of each featured fugitive, an online tip form and the Office of Inspector General hotline number to report information in either English or Spanish. The website will be updated if a fugitive is apprehended.

Government creates 'Most Wanted' list for healthcare fraud | Healthcare Finance News


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