May 12, 2011
In an effort to publicize its search for individuals committing healthcare fraud, the Office of the Inspector General has created its own "MOST WANTED" list, featuring over 170 individuals being sought for healthcare fraud. The laundry list of allegations against some of the "Most Wanted" is severe and somewhat shocking, however, some of the individuals named have provided "medically unnecessary" care and no amount of what they defrauded the government out of is listed. This raises a level of concern given the number of audits that have been initiating against providers for "medically unnecessary" care - where does such care raise to the level of "fraudulent" activity? The general test that is applicable would be whether claims submitted qualify as "False Claims" under the False Claims Act - and whether such claims were submitted "knowingly" or intentionally to a third party payor payable with government funds.
OIG's "Most Wanted" list also allows citizens to "report" on the location of the "Most Wanted" or to send in information on others possibly committing fraud.
To check out OIG's MOST WANTED, click here.
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