Mathias Consulting - Healthcare Policy and Technology, Resources, Fraud Cases, Healthcare Fraud Control Articles, Library

You might have noticed

Mon, 27 Jul 2009 21:48:27 -0700

You may have noticed that I haven’t be updating the site in a long time. I’m taking a break from this field.

I hope you find the information helpful. If you’re trying to report fraud, contact your state’s Attorney General. This site includes links to Attorney General offices, but they may be out of date.

Friends and colleagues feel free to contact me. The contact information you have is still correct and I will receive your messages, phone calls, etc. You can also find me on LinkedIn.com.

Robin's Fraud Control Toolbox

Thu, 9 Aug 2007 19:40:30 -0700

There is no single tool that will identify all fraud. Here are some of the tools you’ll need in your toolbox. Add one or two tools at a time to build a full defense against fraud:

Basic edits and audits
Computer Network Security
Rules Based Post-payment Analysis
Random Audits
Outside Data Sources & Social Network Analysis
Geographic Information Systems (GIS)
Predictive Modeling
Advanced Prepayment Edits
Biometrics

Florida Businessman Sentenced in Health Care Fraud Scheme

Thu, 29 May 2008 17:57:46 -0700

Florida Businessman Sentenced in Health Care Fraud Scheme - Leonardo Pita, the owner of a durable medical equipment company based in Miami-Dade County, Florida, was sentenced to 42 months in prison, followed by three years of supervised release, and ordered to pay over $519,000 in restitution following his convictions for Medicare fraud and money laundering. [Google Reader]

Alabama Couple to Plead Guilty to Medicare Fraud

Thu, 29 May 2008 17:46:35 -0700

Alabama Couple to Plead Guilty to Medicare Fraud - William Lloyd King, Jr. and Marie Weller King, both of Birmingham, Alabama, have each agreed to plead guilty to their involvement in a Medicare fraud scheme.

Profiles in Courage: Citizens against Fraud - OpEdNews

Thu, 29 May 2008 12:57:03 -0700

Profiles in Courage: Citizens against Fraud - OpEdNews -
Profiles in Courage: Citizens against Fraud

Local doctor indicted on drug, fraud charges - Norman Transcript

Thu, 29 May 2008 12:56:22 -0700

Local doctor indicted on drug, fraud charges
Norman Transcript, OK - 8 hours ago
The indictment alleges Phung illegally billed the Medicaid program, through the Oklahoma Health Care Authority, for the evaluation and management of …

Dublin Doctor Defrauds Medicare, Medicaid, Gets Four Years ... - Rockbridge Weekly

Thu, 29 May 2008 12:42:32 -0700

Dublin Doctor Defrauds Medicare, Medicaid, Gets Four Years … - Rockbridge Weekly -
Dublin Doctor Defrauds Medicare, Medicaid, Gets Four Years …

No Rides for Medicaid Patients - WCAX

Thu, 29 May 2008 12:44:20 -0700

No Rides for Medicaid Patients - WCAX -
No Rides for Medicaid Patients

Fact Sheet: Department of Justice Efforts to Combat Health Care ... - PR Newswire (press release)

Thu, 29 May 2008 12:41:52 -0700

Fact Sheet: Department of Justice Efforts to Combat Health Care …
PR Newswire (press release), NY - 22 hours ago
Federal and state agents included personnel from HHS-OIG, the FBI, City of Hialeah Police Department, and the Florida Medicaid Fraud Control Unit. …

Prepared Remarks of Attorney General Michael B. Mukasey on the ... - Biloxi Sun Herald

Thu, 29 May 2008 09:50:28 -0700

Prepared Remarks of Attorney General Michael B. Mukasey on the … - Biloxi Sun Herald -
Prepared Remarks of Attorney General Michael B. Mukasey on the …

Fact Sheet: Department of Justice Efforts to Combat Health Care

Thu, 29 May 2008 09:47:24 -0700

Fact Sheet: Department of Justice Efforts to Combat Health Care … - PR Newswire (press release) -
Fact Sheet: Department of Justice Efforts to Combat Health Care …

Missouri AG Nixon Recovers $462926 In Ongoing Medicaid Fraud

Thu, 9 Aug 2007 19:31:17 -0700

Attorney General’s News Release

August 7, 2007
Nixon recovers $462,926 in ongoing Medicaid fraud investigation in Dekalb County

Jefferson City, Mo. — Attorney General Jay Nixon announced today that the Missouri Medicaid program will be receiving $462,926 from a pharmacy in DeKalb County that is under investigation for Medicaid fraud. Nixon said the Medicaid Fraud Control Unit in his office has recovered the money from the Randolph Drug Store in Maysville.

Texas Physician Sentenced for $10 Million Scam

Thu, 9 Aug 2007 19:18:06 -0700

Press Release
The United States Attorney’s Office
Southern District of Texas

August 6, 2007

LOCAL PHYSICIAN SENTENCED TO PRISON FOR DEFRAUDING INSURANCE COMPANIES OF $10 MILLION

(HOUSTON) Dr. Ira Klein, a physician who specialized in treating Hepatitis C patients, has been sentenced to more than 11 years in federal prison, without parole, for health care and mail fraud, United States Attorney Don DeGabrielle announced today.

Attorney General Abbott Recovers $15.7 Million In Medicaid Costs Under National Settlement (PharmaLive)

Sat, 9 Dec 2006 08:57:40 -0800

PharmaLive: Attorney General Abbott Recovers $15.7 Million In Medicaid Costs Under National Settlement

AUSTIN, Dec. 7, 2006 - Texas Attorney General Greg Abbott today announced Texas will receive more than $15.7 million under a national settlement with one of the nation’s largest pharmaceutical companies.

New Nerve Test, a Moneymaker, Divides Doctors (New York Times)

Tue, 14 Nov 2006 06:50:50 -0800

Any test which doctors provide themselves (self-referral) is an opportunity for fraud. To identify suspect cases, measure the number of tests per 1,000 patients for doctors performing the test themselves, compared to those who refer patients to another provider. You may need to make adjustments for patient diagnosis or health status.

Of course looking to evidence is most important. Are these doctors qualified to perform the service? Is the diagnostic test effective as a screening tool or should its uses be more limited? Does the test result in more treatment? Is the treatment effective?

Here are some highlights from an article from the New York Times about a product with high fraud potential: