How to Earn $25 Million Per Year, at Least for a While....

The answer isn't to be an NBA All-Star or an Oscar winning actress. But the good news is a college degree isn't required. Apparently limited Federal oversight over Medicare and Medicaid spending in South Florida has allowed at least one fraudster to "earn" $105 Million over four years before finally getting caught in a recent sting operation.

Clues that led to the prosecution include Department of Health and Human Services include the following:

• The South Florida region billed Medicare more than $2 billion each year for injectable HIV medications. That figure is 22 times as high as the amount of similar claims in the rest of the country, and is far out of line with demographic data in a population of 2 million people in Miami-Dade County, HHS statistics show.
• HHS investigators discovered that nearly half of 1,581 medical equipment companies they visited in the Miami area did not comply with basic Medicare requirements to be open during scheduled hours and to have a telephone number.

For more information on the specific case and some of the troubling patterns suggested, read the MSNBC story.

Those of you familiar with Visual Risk IQ's services know that we combine visual outlier analysis with continuous transaction monitoring, primarily for accounts payable, procurement card, and travel and entertainment. But since summer of 2007, we have also been developing a practice in Health Benefits auditing, in partnership with Atlanta-based Thomas Ray and Associates. Stories like this validate our decision to expand our work into this payment stream, as overpayments through errors and fraud seem much greater than with accounts payable.

More to follow this summer as we continue to continue our work in this highly visible expense area.

Joe Oringel
Visual Risk IQ
Charlotte NC 28277