Ok here's one for the “good algorithms” that audit and track back and match up claims to ensure everything was in divine order.  With analytics those who bill for things out of the ordinary stick out like a sore thumb when a large dollar amount is shown and good to see it’s finally being used to track down fraud.  In addition to lawmakers efforts there’s also the HHS Most Wanted List you can check as well if you think you have seen any of the individuals out on the loose.  Chinese medicine that was administered obviously didn’t code right:)

HHS Creates 'Most Wanted' List Website for Healthcare Fraud - Office of the Inspector General

Last year it was announced that the data base analytics would be available for law enforcement to use when looking for Medicare 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

A doctor and an administrator at a Garden Grove medical clinic have been arrested for allegedly billing Medicare for physical therapy treatment that was never provided, the U.S. Attorney’s Office said Wednesday.

Dr. Byung Ho Pak and Mary Lim were arrested Wednesday morning as part of federal sweep in six regions of the U.S. Pak and Lim, while working at Seoul East West Medical Center, billed Medicare $2 million for physical therapy, according to an indictment. Patients, however, were given treatments that weren’t covered such as acupuncture and moxibustion, a traditional Chinese medicine skin treatment.

The clinic collected more than $1.4 million in payment, according to the indictment.

In all, the Medicare Fraud Strike Force charged 70 people across the U.S. with $264 million in Medicare fraud. The multi-agency team uses data analysis to help identity fraud.  Also arrested in the sweep was a Los Angeles doctor who once practiced in Fountain Valley. He was charged with fraud for allegedly performing unnecessary tests or billing for ones never performed. Dr. Owusu Firempong, 60, submitted $1.3 million in fraudulent claims, according to prosecutors.



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