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Healthcare fraud action highlights ongoing problem

Healthcare fraud action highlights ongoing problem

The sweep of healthcare fraud cases announced by the Justice Department is sweeping and vast. Over $2 billion in fraud was identified by 600 defendants charged across the nation, defrauding health insurance for opiods that were re-sold as well as general services.

A stunning $350 million of that fraud comes from South Florida alone. Those charged come from all over the state, too. Prosecutors make it clear that this is only the tip of the iceberg, however, and there is much more that they have not yet uncovered.

The enforcement operation

It appears to be the largest operation ever undertaken against healthcare fraud. The press often highlights the abuse of Medicaid reimbursements, but private insurance companies were caught up in it as well.

Like much of the fraud today, it involved a vast network of doctors, clinics, patients, and services all working together. It even connected the opiods obtained with false prescriptions to a drug cartel that is traffic in them.

Much is South Florida based

Fully 20% of the defendants ensnared are from South Florida. In the Tampa area alone, 13 defendants including four doctors have been charged. The network of fraud reached out all across the nation but was clearly centered here.

The $350 million in fraud in South Florida came from nearly every aspect of the healthcare industry, too. All insurers in the state have probably been defrauded, at least in part, by this operation. And officials are stressing that this is only what is known at this time, there is likely to be more.

What can be done?

Fraud that is identified by the Justice Department can be recovered. It takes experience in insurance fraud to navigate a case like this, especially when the operation is so vast and criminal charges are involved. More importantly, there may be evidence in the criminal trial which highlights other fraud not currently charged.

Insurance fraud is so common in South Florida that vigorously pursuing it is critical for any insurer. A legal team with a proven track record pursuing every case to full recovery can make a large difference in the bottom line for any insurer operating in Florida.

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