Health Care: Fraud Schemes Committed by Career Criminals

Health Care: Fraud Schemes Committed by Career Criminals

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Health Care: Fraud Schemes Committed by Career Criminals and Organized Criminal Groups and Impact on Consumers and Legitimate Health Care Providers. Washington: United States General Accounting Office, 1999. Not available online. Contact us.

You’ve got to read this report. It shows how fraud can spread easily from state to state, insurer to insurer and scam to scam. Perpetrators use family members, friends and former cellmates to franchise their scams. “In the North Carolina Medicare case, three subjects residing in North Carolina traveled to Florida where relatives taught them how to anonymously file false Medicare claims. They then returned to North Carolina and began filing such claims.” Unless people in your state don’t have any connections to people in other states, chances are, somebody is using a sophisticated scam that they learned elsewhere.

This analysis of 7 fraud cases illustrates how organized crime has infiltrated Medicaid, Medicare and private insurance. “In six of the seven cases we reviewed, individuals in the criminal groups incorporated or otherwise set up as many as 160 medical clinics, physician groups, diagnostic labs, and/or DME companies to submit fraudulent or allegedly fraudulent public and/or private health insurance claims.”

Perpetrators used mailboxes in many counties and states to try to avoid detection. A perpetrator in Dade County setup mailboxes all over the state, because “insurance companies know Miami is a ‘hot spot’ for health care fraud activity and are less suspicious of claim payments going to addresses outside the Miami area.”