On June 22, 2016, the United States Attorney General announced the largest combined Medicare, Medicaid and Tricare fraud take-down of healthcare professionals and others in history. The 2016 record-setting $900,000,000.00 bust involved 301 doctors, nurses, pharmacists, physical therapists, occupational therapists, clinic operators, patient recruiters, patients, and others across 36 federal jurisdictions – eclipsing the 2015 round-up of 243 individuals for $712,000,000.00 of federal healthcare fraud.
“Doctors’ roles were critical,” abusing basic doctor-patient relationship trust (bespeaking medical malpractice), newswires headline. Bogus claims included doctors filling out blank prescription forms, patient recruiters targeting poor drug addicts, money laundering, patient kickbacks, and related conspiracies.
Notably, federal enforcement is data-driven, using advanced analytics of claim reimbursements. Use of “Neo4j” of Neo Technologies by Mitre Corp. is highlighted.