US Attorneys Fight the Crime of Healthcare Fraud. But Is it Enough?
Healthcare fraud is on the rise. Even more so now during the pandemic.
The Criminal Division of Health Care Fraud Unit of the Justice Department, “HCF”, is comprised of 70 prosecutors who are solely focused on healthcare fraud related crimes.
This unit is organized much the same way as the Drug Enforcement Unit (DEA). It works in collaboration with the FBI, Office of the Inspector General, U.S. Attorney’s Offices as well as local law enforcement.
Signaling the impact of healthcare fraud, the HCF Unit engages a “National Rapid Response Strike Force.” Operating eleven “Strike Force Units” in major metropolitan regions and states across the country.
Recent Strike Force indictments include large-scale rural hospital fraud in Florida, resolution of fraud by Tenet HealthCare Corporation, and numerous prosecutions of criminals exploiting the COVID-19 pandemic.
Reports on JUSTICE.GOV reflect the diligent and vigilant work that the DOJ is conducting to thwart healthcare fraud. Yet indictments and convictions continue as criminals run mostly unabated with brazen indifference to the impact on individuals, healthcare institutions, insurance companies and the Federal Government.
Here are just a few recent examples…
Pharmacy Owner and Accountant Indicted in $134 Million Healthcare Fraud Scheme
• US Attorney’s Office: Southern District of Texas – March 9, 2021
U.S Court of Appeals Affirmed Judgement Against Multiple Individuals for Defrauding Medicare And Tricare.
• US Attorney’s Office: District of South Carolina – March 8, 2021
Former Police Officer Admitted role in Multi-Million Dollar Compounded Prescription Scheme.
• US Attorney’s Office: District of New Jersey – March 8, 2021
$2.1 Million Fine by Roanoke Allergy and Asthma Medical Practice Guilty of Fraudulent Billing.
• US Attorney’s Office: Western District of Virginia – March 2, 2021
Four Imposter Physicians Conned Patients. Charged For $32 Million Heath Care Fraud.
• US Attorney’s Office Southern District of Texas – March 2, 2021
Convictions in Prescription Billing Fraud. Two facing 20 years in prison and 250,000 fines.
• US Attorney’s Office: Northern District of Alabama – March 1, 2021
Prescription Drug Diversion Scheme Nets Fraudster 8 1/2 Year Prison Term.
• US Attorney’s Office: Southern District of Florida – February 26, 2021
Nursing Home Indicted for Falsified Records
• US Attorney Office: Western District of Pennsylvania – February 25, 2021
Is the Justice Department Strike Force Enough For Us to Sleep Easy?
The answer is regrettably, NO.
While the Justice Department is aggressively pursuing healthcare crime, indictments and convictions are occurring “after the horse left the barn.” Success at locking up and fining the criminals has not served as a deterrent.
With billions of dollars involved, it’s vital for any business, especially insurance companies, large scale medical practices and mid-to-large-cap corporations to have the ability to detect and protect against healthcare fraud in real-time…
BEFORE IT HAPPENS!
How?
Artificial Intelligence based anti-fraud technology has become the weapon of choice in addressing the increase in frauds including healthcare fraud and cybercrimes.
The leader in the field of Advanced Transactional AI is ToolCASE. The Best-In-Class solution for healthcare fraud and risk management.
ToolCASE’s cutting-edge solutions include proprietary RembrandtAI, RembrandtX, Informant and US3. The world’s most advanced artificial intelligence.
These are powerful tools for anticipating and resolving customer inquiries, prior authorizations, review of claims, membership management, billing and regulatory compliance via automated reporting and regulatory updates.
And most importantly, ToolCASE can detect fraudulent activities in real-time. Giving your organization the ability to stop fraud before the criminals get away.
Working in concert, the ToolCASE suite of products offers your organization real-time monitoring of transactions and pattern analytics. It identifies anomalies and provides easily understood visualization and alerts.
These are mission critical functions to detecting and protecting your organization against healthcare and other forms of financial fraud.
