Robin Mathias's blog

Google Helps Solve Cases

News and Commentary
Google IDs 1993 hit-and-run victim - MOXEE, Washington (AP) — Google, the Internet search engine, has done something that law enforcement officials and their computer tools could not: Identify a man who died in an apparent hit-and-run accident 11 years ago in this small town outside Yakima. [CNN Technology]

While this is not about healthcare fraud, it shows that creative use of resources can help solve cases. One way of using Google to find fraud is to search for keywords related to illegal marketing practices. For example, you could search for “free chiropractic exams.” The first article I found was My Visit to a Straight Chiropractor, which is an excellent article about a visit to the chiropractor in response to a telemarketing call. It gives a great explanation of the kinds of scams we’re looking for.

Texas Celebrates Losing Battle

News and Commentary | Healthcare Policy and Technology
September 2004 Texas announced that they had increased Medicaid Fraud Control Unit (MFCU) staff from 36 to 110, and expect to increase to at least 200 by the end of fiscal year 2005. In FY 2004 the MFCU doubled the number of cases it opened, the number of cases presented for prosecution and the number of cases in which criminal charges were filed. Identification of illegal overpayments made to fraudulent operators has increased by 85 percent to over $27 million. Last month the U.S. Department of Health and Human Services recognized Texas by awarding them the annual Inspector General’s State Fraud Award.

Greedy Dentists Busted in California

News and Commentary | Dental Fraud Cases | Fraud Cases | Kickbacks | Medicaid Fraud Cases

“It’s all about the money,” was the operating creed of Hatch Dental, as described in a 42-count felony complaint filed by California Attorney General Bill Lockyer on September 22, 2004. The complaint describes how 20 defendants affiliated with three Hatch Dental clinics let greed rule their practice at the expense of patient health and safety.

In spring of 2002, when Brian Kanarek, DDS asked defendant Kyon Maung Teo (the alleged ringleader) why he over-diagnosed treatment, Teo told him, “Something has to pay for this practice.” After Kanarek diagnosed only 2 fillings for a patient whom Teo diagnosed 26, Teo told him to leave Hatch Dental “and don’t come back.”

Moist Nose Shows Promise in Tracking Down Cancers

News and Commentary
Moist Nose Shows Promise in Tracking Down Cancers - British researchers have trained dogs to detect bladder cancer by sniffing human urine, opening up the possibility that dogs may one day be used to detect the disease. [New York Times Healthcare News] I love dogs. I can just imagine the canine job advertisements we’ll soon be seeing: Medical facility seeks talented, responsible canine for dream job. Sniff pee all day while your human is at work and make a little money to replace those slippers you ate when you were a wee pup.

Sept-Oct 2004 Fraud News

Newsletters

This issue:

  1. Featured Case: eBay Used for Medical Supply Fraud
  2. What to do before you contact the prosecution
  3. States up in arms over Payment Error Rate Measurement Rule

1. eBay Used for Medical Supply Fraud

In Washington last week, deputies arrested Sally Hansen after they caught her selling medical supplies on eBay. The supplies were allegedly paid for by Washington state for Hansen’s disabled child. The Seattle Post-Intelligencer reported thta the state Department of Social and Health Services paid $15,100 for diapers, fruit drinks, and PediaSure, and a state employee health insurance program paid about $23,000 for medical supplies for Hansen’s daughter.

eBay Used for Medical Supply Fraud

News and Commentary | Fraud Cases | Medical Equipment Fraud Cases

In Washington last week, deputies arrested Sally Hansen after they caught her selling medical supplies on eBay. The supplies were allegedly paid for by Washington state for Hansen’s disabled child. The Seattle Post-Intelligencer reported thta the state Department of Social and Health Services paid $15,100 for diapers, fruit drinks, PediaSure and a state employee health insurance program paid about $23,000 for medical supplies for Hansen’s daughter.

The investigation reportedly started after Wanda DeGolier bought PediaSure from Hansen on eBay. Ms. DeGolier contacted the medical supply company after she noticed that a label on the box that said the supplies were intended for Hansen’s daughter. Read the Seattle Post-Intelligencer article

ACFE Insurance Fraud Conference

News and Commentary

I spoke at the ACFE Insurance Fraud Conference in Hartford, CT August 24. You can download my presentation materials, download the article or read the article online.

Some of the other presentations were facinating, especially the presentation Cam Towers Jones did called Prosecuting Multi-Jurisdictional Health Care Fraud Cases. Ms. Jones is the Assistant United States Attorney with the Criminal Division, Western District of Tennessee. Previously, she as the Health Care Fraud Coordinator for the Executive Office for the United States Attorneys, Washington, DC.

Hospitals, Providers Move Toward 'Paperless' Age

News and Commentary
Hospitals, Providers Move Toward ‘Paperless’ Age - Wsbtv.com - Wed Aug 4, 01:57 pm GMT [News4Sites Healthcare]

Last weekend, Aron, a professor of medicine showed me the Electronic Medical Records (EMR) system used at his hospital. This is not simply a way to electronically store information that used to only be on paper. It is an incredible step towards better medicine.

His laptop has a touch screen that allows him to quickly check boxes, which is how he enters most of the information during a visit. Aron showed me some hypothetical cases that he created to use in the classroom.

Hospital accused of Medicare fraud

News and Commentary | Fraud Cases | Kickbacks
Hospital accused of Medicare fraud (Miami Herald) - Larkin Community Hospital, in South Miami, and many connected with it are alleged to have bilked Medicare of millions of dollars. [Healthcare Fraud News] According to this article, “At one point, the civil suit states state regulators found that half of all care being given in the small South Miami hospital was medically unnecessary.” The article describes two scams. The first scam involves alleged kickback payments to Jack Jacobo Michel, a physician who later bought the hospital. The second scam involves kickbacks to long-term care facilities, some of which were owned by Jack Jacobo Michel, who at that time, also owned the hospital.

Doctor Indicted: Chemotherapy Drug Scam

News and Commentary | Fraud Cases | Prescription Drug Fraud
Doctor Indicted - A Middle Tennessee doctor has been indicted on healthcare fraud charges. Dr. Young Moon practices in Crossville. [Healthcare Fraud News] This is part of a trend that first gained national attention in 2001, when Robert Courtney, a pharmacist, was indicted for diluting chemotherapy drugs. He pleaded guilty in 2002. Since the effectiveness of chemotherapy varies greatly, patients don’t know for sure whether they are getting full doses.
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