Monday, July 16, 2018

Foot Fraud

To put oneself in the shoes of another is to understand the circumstances or experiences of someone else. (I would be extremely reluctant to put my feet in the shoes of a fraudster because I would not want to experience the life of a...

Compounding Problems

A pharmacy owner in Decatur, Alabama recently compounded problems for his business when he devised a healthcare fraud scheme that stole from TRICARE, the U.S. Department of Defense’s military health system. The pharmacy owner used his business to bilk more than $10 million from the government health insurance program and military families who deserved the benefits.

Feeding Fraud

If a patient is unable to consume food or liquids by mouth, doctors may prescribe a feeding tube that can be put directly into the stomach through the abdomen. This procedure bypasses the mouth and esophagus and goes directly into the intestinal system,...

Modus Operandi

Fraudsters consider lying to be an important part of their modus operandi. (It's just part of the job description.) A Federal Bureau of Investigation (FBI) press release tells about a Louisiana doctor who scammed Medicare out of millions of dollars by lying about the...

The Power of Persuasion

We are impacted by persuasion every day. Just turn on the television and within a few minutes, you’ve watched at least one commercial, if not more, advertising a sizeable discount if you call a toll-free number, log-on to a website, or run on down...

Drowning in Pills

According to the Centers for Disease Control and Prevention, opioid prescriptions are linked to more than 40 percent of all U.S. opioid overdose deaths. (More than 200,000 people died from prescription opioid overdoses between 1999 and 2016. Just during 2016, more than 46 people...

Permission Slip for Fraud

Permission slips come in different forms. Schools require them so that children can visit the local zoo on their class trip. Doctors request a signature from a patient getting the flu shot stating there are no allergies to the vaccine about to be administered....

What Goes On Behind Closed Doors

Appearances can be deceiving. Someone can be perceived as a pillar of the community, but hide behind a public persona and commit a private crime. (They somehow reason that no one would suspect such a devious act from someone so revered.) An article published...

Monkey See, Monkey Do

Parents’ actions often speak louder than words. And, when children observe their parents repeating the same behavior frequently, they tend to copy. (Monkey see, monkey do.) A woman from Placentia, California emulated her mother’s repetitive criminal behavior and followed her lead right into a...

The Opioid Crisis: When Healthcare Fraud Turns Deadly

The Opioid Crisis is now a Public Health Emergency. Combating the crisis and the criminals using fraud to perpetrate it (and often using taxpayer-funded dollars to do so), is critical. It is going to take data from multiple sources – providers, medical claims, pharmacy claims, public records, law enforcement records management system, computer-aided dispatch and more – to win. Siloed data will be the enemy of success, but data sharing will enable success.

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