2015 Annual Training Conference & Anti-Fraud Expo

Sessions Speakers Exhibitors Show Specials Floor Plan Buzz

Compromised Clinics and their impact on Medicare Part A, B, and D Fraud (Room Seaport F)

Faculty will describe a large scale fraud scheme involving multiple interrelated prosecuted cases which are linked to over $40 million dollars in Part D fraud and tens of millions of dollars in Part A and B Fraud. The presentation begins with case studies of two Miami clinics whose employees and owners were stealing prescriptions from two of the highest prescribing Part D providers in the nation. The presentation will explain how these two clinics enabled over 40 suspect pharmacies and home health agencies to bilk millions of additional dollars from the Medicare Part, A, B, and D programs. The presenters will explain several of the investigative techniques utilized to uncover, investigate, and link this massive fraud ring. The presenters will discuss the key players involved in the schemes and some of the unique aspects of the cases such as undercover operations, fugitive apprehensions, drug diversion, data analysis links. The presenters will explain the roles of law enforcement and other related health care fraud investigative entities involved in these cases. Finally the presenters will highlight various recurring fraud trends relevant to the case studies and how to reduce the chances of this type of criminal health care fraud from being committed in the future.