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  • Geebo 9:00 am on November 10, 2025 Permalink | Reply
    Tags: , , medicaid, , ,   

    America’s $14.6B Healthcare Fraud Crackdown Explained 

    By Greg Collier

    In June 2025, the U.S. Department of Justice announced the largest healthcare fraud takedown in American history—charging 324 defendants, including doctors, medical business owners, and executives across 50 federal districts.

    The alleged schemes totaled more than $14.6 billion in intended losses, much of it tied to Medicare, Medicaid, and COVID-19 relief programs.

    While the headlines focus on the massive numbers, the real story is how fraudsters turned public health programs—designed to help the sick and elderly—into billion-dollar criminal enterprises.

    What’s Going On:

    This nationwide enforcement sweep—coordinated by the Health Care Fraud Strike Force and HHS-OIG—uncovered multiple overlapping schemes, including:

    • Telemedicine & Lab Fraud: Criminal networks billed the government for fake telehealth sessions and unnecessary lab tests never performed.
    • Pharmacy Kickbacks: Pharmacies paid illegal referral fees for patient data to over-prescribe controlled substances or expensive specialty drugs.
    • Durable Medical Equipment Scams: Fraudulent suppliers billed Medicare for wheelchairs, braces, or monitors that were never delivered.
    • COVID-Relief & Opioid Fraud: Some defendants misused pandemic programs to launder funds or obtained opioids under false pretenses for resale.

    Authorities say the operation prevented over $4 billion in payments on false claims and revoked billing privileges for hundreds of providers before more damage occurred.

    Why It’s Effective:

    Healthcare fraud succeeds because it exploits complexity and trust:

    • Complex Billing Systems: Medicare and Medicaid process millions of claims daily—fraudulent invoices blend in easily.
    • Blind Trust in Providers: Patients rarely question a doctor’s orders or medical billing.
    • Limited Oversight Bandwidth: Agencies under pressure to process claims fast can miss red flags.
    • High Dollar Incentives: Each false claim can yield thousands—creating lucrative opportunities for organized crime groups.

    It’s not always shadowy hackers behind these crimes—sometimes it’s insiders, executives, or licensed professionals misusing legitimate systems for profit.

    Red Flags:

    Whether you’re a patient, healthcare worker, or caregiver, stay alert for:

    • Medical bills or claims for services you didn’t receive.
    • Unknown providers listed on insurance or Medicare statements.
    • “Free medical equipment” offers requiring your personal or insurance info.
    • Unsolicited calls or emails claiming to verify your Medicare number.
    • Duplicate billing or inconsistent charges for the same treatment.

    Quick Tip: If you get an Explanation of Benefits (EOB) that doesn’t match your memory of care, contact your insurer directly—not the number on the suspicious bill.

    What You Can Do:

    • Monitor your records: Check your insurance statements and Medicare Summary Notices monthly.
    • Protect your data: Never share your Medicare or insurance ID over the phone unless you initiated the call.
    • Freeze your credit: Prevent identity-based fraud before it starts.
    • Ask questions: If a provider insists on unnecessary procedures or “free” add-ons, it’s okay to say no.

    Report fraud fast: File reports through OIG.HHS.gov or the FTC’s ReportFraud.ftc.gov.

    For medical professionals:

    • Conduct regular billing audits.
    • Verify third-party vendors and billing partners.
    • Train staff to flag suspicious claims patterns.

    If You’ve Been Targeted:

    1. Contact your insurer or Medicare to flag unauthorized claims.
    2. Report the fraud to HHS-OIG or the National Healthcare Anti-Fraud Association (NHCAA).
    3. File an identity theft report at IdentityTheft.gov if your personal data was compromised.
    4. Document everything: Keep copies of fraudulent bills, letters, and communications.
    5. Notify your doctor or clinic: Fraud under your name may affect your medical record accuracy.

    Final Thoughts:

    Fraud in healthcare doesn’t just cost money—it erodes trust. Every fake claim drains resources meant for real patients.

    The DOJ’s $14.6 billion crackdown sends a strong message: fraudsters will be caught, but prevention starts with awareness at every level—patients, providers, and payers alike.

    Scammers will always chase complexity. But vigilance, education, and transparency are still the best medicine.

    Further Reading:

     

  • Geebo 8:00 am on October 6, 2025 Permalink | Reply
    Tags: , , , medicaid, , ,   

    Shutdown Fuels Federal Impostors 

    Shutdown Fuels Federal Impostors

    By Greg Collier

    With the federal government shutdown creating uncertainty across the country, consumers are being urged to stay alert for scams that exploit the disruption. Officials in North Carolina recently issued a warning after seeing signs that criminals are using the shutdown to impersonate federal agencies and obtain personal or financial information. The concern is not limited to one state, since the agencies being mimicked operate nationwide and shutdown-related confusion affects people in every region.

    Past shutdowns have shown that scammers quickly adjust their tactics to match the moment. During previous funding lapses, people reported fraudulent claims about suspended Social Security checks, frozen food assistance, or threats that Medicare coverage would end unless immediate action was taken. In some instances, callers falsely offered help to federal workers or contractors struggling with missed paychecks, using the shutdown as cover to push loans or collect personal data.

    These schemes commonly arrive by phone, text message, or email and rely on pressure and urgency rather than credibility. Scammers often use caller ID spoofing or fake email domains to make their messages appear to come from federal agencies. That technology can make it difficult for people to immediately recognize that the communication is fraudulent.

    Government officials are emphasizing that legitimate agencies will not make unsolicited requests for sensitive information or demand payment through gift cards, wire transfers, or similar methods. Any unexpected outreach from someone claiming to represent a federal program should be treated with caution. People are encouraged to end the communication and reach out directly to the agency using verified contact information if there is reason to confirm anything.

    In North Carolina, the Consumer Protection Division of the state Department of Justice is continuing to accept fraud complaints during the shutdown. Other states have similar channels for reporting suspicious activity. Remaining cautious, especially when receiving messages that appear urgent or threatening, is one of the most effective ways to prevent financial or identity theft while the shutdown continues to create opportunities for exploitation.

     

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