In a scheme mirroring the “corrupted retailer” scheme seen in SNAP, fraud in Medicaid is on a massive scale; transnational criminal organizations (TCOs) partner with or establish dishonest medical providers and durable medical equipment provider (DME) companies, or diagnostic laboratories.
The corrupt provider submits electronic claims stating they performed complex genetic testing, physical therapy, or telemetry monitoring on hundreds of synthetic ghost patients. Because the identity numbers are valid and active within the MCO or fee-for-service system, claims are automatically processed, and federal/state matching funds are paid directly into the providerā€™s business account.
Is your organization keeping up with the fraud trends of domestic and transnational crime groups?
At CoventBridge Group, our teams monitor real-time trends and activities and specialize in identifying ghost providers, clients, and medical offices created by corrupt providers and organized crime groups.
