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Arsenal of tools to probe, prosecute medical fraud ever-expanding

Government regulators and law enforcers -- both federal and state, working singly and in concert -- have unquestionably ratcheted up fraud-linked investigatory efforts in recent years.

Their resolve has been coupled with deep money reserves and considerable manpower marked by task forces and broad-based agency involvement. It has also been clearly on display across the country, including prominently in Texas (please see any number of our blog posts at Hilder & Associates featuring a Texas-tied fraud connection).

Virtually every realm involving government contracts and payouts has been targeted, ranging from construction to defense spending.

And medical care, of course. In fact, probes targeting wrongdoing in the health care sphere are especially apparent, given the country’s aging population and massively sized programs like Medicare and Medicaid. Stories spotlighting medical fraud are so common as to be mundane these days.

One recent media focus on health care fraud underscores the sheer depth and breadth of resources devoted to spotting it and following through with criminal prosecutions of alleged wrongdoers.

That American Bar Association Journal piece stresses the potent investigatory punch that has been a mainstay marking medical fraud cases. Multiple enforcement groups often combine resources and work together in fraud probes, supplementing traditional enforcement strategies and techniques with inside tips from whistleblowers and witnesses.

And, the ABA centrally notes, evolving technology is now playing a huge role in fraud investigation, relying heavily on so-called data analytics. A principal with the U.S. Department of Justice stresses that data mining is now the “foundation of how we investigate and analyze cases.”

Principals in the nation’s health care industry are clearly on notice. Their routine activities -- ranging from appointments and treatment recommendations to billings and other matters -- are subject to close scrutiny by government regulators and law enforcers.

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