As part of its efforts to coordinate the fight against fraud across the nation’s health care systems, including Medicaid and Medicare, data mining will allow Florida’s MFCU to sort electronic claims through the use of statistical models and intelligent technologies to uncover patterns and relationships. Using the identified patterns, investigators can review Medicaid claims activity and history to find abusive or abnormal use of services and billing that may be potentially fraudulent. Data mining is done with software programs which include algorithms that automatically analyze the MMIS data.
Archive for the ‘fraud’ Category
General Reinsurance Corporation Enters into Agreement Resolving Its Role in Fraudulent Reinsurance Transaction with AIG
As part of the agreement, General Re admitted its senior management participated in structuring a sham reinsurance transaction and creating a phony paper trail to make it appear as though General Re’s subsidiary, Cologne Re Dublin, had solicited reinsurance from AIG when the evidence demonstrated that the parties knew AIG wanted the transaction to manipulate its financial statements. Additionally, General Re entered into a secret side deal whereby AIG would never have to pay any losses under the contracts; AIG would return to General Re’s subsidiary the $10 million in premiums General Re’s subsidiary paid to AIG and AIG paid General Re an illicit accommodation $5 million fee for entering into the transaction.
Minnesota Hospital to Pay U.S. to Resolve Allegations of False Claims Involving Unnecessary Admissions
“Hospitals and doctors have a responsibility to provide patients with reasonable and necessary care. When they neglect those obligations, patients and taxpayers suffer
Former Owners of Medical Equipment Company Sentenced to Prison for Defrauding Medicare in Wheelchair Scam
At a hearing this morning, U.S. District Judge Ewing Werlein Jr. sentenced Amudat Williams, 54, and his spouse and co-defendant Sunday Adebisi to 44 months each in federal prison without parole and ordered them to jointly to pay $2,190,772 in restitution to Medicare. Williams and Adebisi, both of Houston, were convicted after pleading guilty on Dec. 18, 2008, to conspiracy to commit health care fraud and receiving kickbacks. During today’s proceedings, Judge Werlein further ordered that neither Williams nor Adebisi were to have any involvement with the operation of a business that submits claims to the Medicare program.
Scheme Involved Sales of Customers’ Securities Worth More Than $1.25 Billion
California Court Permanently Enjoins Developer of the “Derivium” “90% Loan” Tax Scheme Scheme Involved Sales of Customers’ Securities Worth More Than $1.25 Billion WASHINGTON – A federal judge in San Francisco has barred Charles Cathcart of Tuxedo Park, N.Y., from promoting a complex tax scheme involving numerous entities located around the globe and sales of [...]
Justice Department Recovers $2.4 Billion in False Claims Cases in Fiscal Year 2009; More Than $24 Billion Since 1986
“Rooting out fraud and safeguarding taxpayers from illegal conduct are among the Justice Department’s highest priorities,” said Tony West, the Assistant Attorney General for the Civil Division. “I applaud the dedication of the public servants who investigate and prosecute fraud, and the courage of the many private citizens who risk their careers by reporting fraud.”
New Jersey Hospital to Pay $3 Million to Resolve Allegations of Medicare Fraud
Both of the hospitals are defendants in a suit brought by a whistleblower, Tony Kite, in 2005. The lawsuit involved allegations that the hospitals fraudulently inflated their charges to Medicare patients to obtain enhanced reimbursement from Medicare.
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