US: Texas men accused of $150M fraud: phony Medicare billing, money laundering 

Drugs by Images Money

From the Valley Morning Star news item: …All four men are charged with conspiracy to commit health care fraud and conspiracy to commit money laundering. They also are accused of fraudulently keeping patients on hospice for multiple years to increase revenue from Medicare. Prosecutors say Mesquias and McInnis used the funds to buy a Porsche, […]

Report: Illinois’ home health care industry rife with fraud, tainted by unscrupulous physicians 

Aging at home

From the Chicago Tribune news report: …For adults hobbled by disability or disease who want to stay out of nursing homes or hospitals, home health care services can be a godsend. For criminals who want to tap into federal Medicare dollars, it can represent a loosely guarded bank vault. A Tribune investigation reveals that Illinois […]

USA — Owner of home health company sentenced to 80 years in prison for Medicare fraud 

From the Becker’s Hospital Review news article: The owner of a home health company in Houston was sentenced Dec. 8 to 80 years in prison for his role in a $13 million Medicare fraud scheme and for filing false tax returns, according to the Department of Justice. In November 2016, Ebong Tilong pleaded guilty to conspiracy […]

U.S. — Guilty of Insurance Fraud, Illinois Chiropractor Gets 20-Month Prison Term 

Crime Scene - Do Not Cross. by Alan Cleaver

From the Insurance Journal item: A suburban Chicago chiropractor has been sentenced to 20 months in prison for billing an insurance company more than $4 million for treatment that was unnecessary or never provided. Federal prosecutors said Thursday 46-year-old Steven Paul of Northbrook pleaded guilty to one count of health care fraud. U.S. District Court […]

U.S. — Prosecutors insist eye doc stole $136 million from Medicaid 

From the ABC News article: …Prosecutors are seeking 30 years. They say the doctor subjected elderly patients to painful tests and treatments they didn’t need, for diseases they didn’t have, to support a vacation home in his native Dominican Republic, lavish trips to Europe and outside business interests. The government also says he bribed New […]

Canada: Pharmacist fakes robbery at his own store to cover up fentanyl trafficking 

Pills 1 by e-Magine Art

From the Ottawa Citizen article: An Ottawa pharmacist who faked a robbery at his own drugstore to cover up the “mountains” of fentanyl patches he trafficked has been found guilty of his crimes, in what appears to be the city’s first case of narcotics trafficking in the profession and the latest effort to deal with […]

Ex-WellCare general counsel gets six months in U.S. prison 

From the Reuters news article: A former general counsel of insurer WellCare Health Plans Inc was sentenced on Wednesday to six months in prison for making a false statement to Florida’s Medicaid program as part of what prosecutors called a $35 million healthcare fraud scheme. Thaddeus Bereday, who was indicted in 2011 along with four […]

OPinion: Finance trumps patients at every level – UK healthcare needs an inquiry 

From the news item: …Pharma companies are not legally bound to sell patients the best treatment, but they are obliged to provide profit for shareholders. Between 2009 and 2014, the industry received fines totalling $13bn for criminal behaviour that included illegal marketing of drugs, hiding data on harms and manipulation of results. As pointed out […]

Canada: ‘Unexplained losses’ of opioids on the rise in Canadian hospitals 

Canadian money by Sara Long

From the Maclean’s article: …Health Canada data obtained by CityNews through an Access to Information request reveal between 2010 and September 2017, opioids went missing from Canadian hospitals 5,689 times and the quantities varied from a few tablets to packs of 100 pills. The highly addictive and potent fentanyl is disappearing from Canadian hospitals at […]

Opinion: Why an insurer invites mandatory fraud reporting (Canada) 

Magnifying glass by John Lester

From the Canadian Underwriter opinion piece: …Aviva released Thursday Crash, Cash and Backlash: Aviva Fraud Report 2017, which includes results of a survey in which two in three respondents said they “feel that cracking down on fraud would reduce their current auto insurance premiums.” That survey is based on interviews of 1,502 Canadians conducted in October by Pollara […]