The alleged false exams were performed over a 2 year period and for $30 million, that’s a ton of billing for sure. The new owner bought the radiology firm and then went to work billing it sounds like and used the names of the radiologist without his knowledge or consent. This will be interesting to see how this plays out as for one they would really have to work hard to completely keep the radiologist out of the picture with seeing some of this but with a second set of books, anything is possible though as it said the billing was done from the new owner’s home and the fact that the name used was the former owner who is a radiologist. These are the types of fraud cases that should be worked and not some of the erroneous billing cases to where less than a million dollars are involved and where cases go back 5 to 10 years like the defibrillator case with hospitals. (see link below).
I would guess that analytics played a part here with identifying this case of fraud with some query parameters established. BD
Hospitals To Get E-Mails From Department of Justice To Examine Questionable Defibrillator Surgeries With Medicare Patients–What A Waste As DOJ Time Is Better Spent With Analytics For Wall Street/Banker Crimes
August 31, 2012 -- The owner of a radiology practice in New York City has been charged by the U.S. Department of Justice with fraudulent billing of more than $30 million in radiology services provided to Medicare and Medicaid patients that allegedly were never performed.
Ting Huan Tai, also known as Warren Tai, was formally charged in a complaint filed on August 30 with false claims of billing for radiology exams between May 2010 and May 2012 for radiological services that were never performed.
The complaint alleges that Tai purchased United Medical Diagnosis (UMD) after the practice's former owner left the firm. Tai and others billed Medicare and Medicaid for $30 million in radiology services that were not performed, using the identity of the radiologist without the doctor's knowledge or consent.
Federal investigators have issued a seizure warrant seeking Tai's allegedly "ill-gotten" gains, which included a Lamborghini automobile. A search warrant also has been executed at Tai's Manhattan residence.
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