Thursday, October 14, 2010

Compliance: "Leave the gun, take the cannolis" (1)

The changing face of health care fraud is becoming more evident, especially fraud committed by non-providers - such as non-existent durable medical equipment shops.

These groups often combine computer hacking, identity theft and bill-and-run phony front offices.

Now a little bit of a new twist.

Today (October 13th) the federal government arrest 73 people charged with racketeering for creating more than 100 phony clinics in more than a dozen states and billing Medicare and Medicaid something like $163 million. The crooks, allegedly with an Armenian "godfather" in charge, stole the identities of both doctors and patients before blitzing the feds with phony billings from non-existent clinics. The "godfather" is in lockup today.

Meanwhile the feds are auditing legitimate providers with contract auditors and cranking up requirements for compliance work. Maybe the feds should pay more attention to internal controls before paying crooks?

(reported via several major wire services)

(1) from The Godfather (part 1)

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