Corporate Compliance

NC fraud enforcement efforts lead to substantial payback

Compliance Monitor, June 29, 2005

Stricter attention to healthcare fraud and abuse is netting record recoveries in North Carolina, according to a June 25 article in the Charlotte Observer.

The U.S. Attorney's Office for North Carolina this month has secured a $1.5 million settlement from an anesthesiologist accused of billing insurers for time he didn't work, as well as a guilty plea from a former pharmaceutical executive who conspired to inflate sales figures and defraud investors, the Observer reported.

The result of extra effort and resources is $28 million recovered from Medicaid fraud and abuse cases to date in fiscal year 2005, representing a 53% increase over 2004's total of $18.3 million, the Observer reported. The 2004 figure was already a 732% increase over the $2.2 million pulled in during 2000.

According to the Observer, the increases in paybacks can be ascribed to the following:

  • Advancements in computer software
  • Assistance from whistleblowers
  • Increases in dedicated staff

"Typically, health insurance fraud is a very complex investigation," North Carolina Department of Insurance Spokesperson Chrissy Pearson told the Observer. "There would be no way to work these cases and see them through to the end without an interested prosecutor."

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