Most Medicare fraud cases in New Jersey start with a whistle blower. Someone on the inside goes to the authorities and lets them in on the scam. But thanks to a new high-tech law enforcement initiative, this might be changing.

The Medicare Fraud Strike Force just got a bit stronger, thanks to a partnership with the Justice Department’s Criminal Division in Washington and specifically, their data analytics unit.

This joint effort will allow the Strike Force to identify aberrations and help to spot fraudulent practices before they waste millions of taxpayer dollars. They are able to identify certain billing patterns that raise red flags and investigate issues extremely quickly, without needing to wait for someone to come forward.

Analysts can now examine in real time:

• How frequently medical providers are billing for certain services or medications.
• What exactly they’re billing for.

NJ is in the top 10 federal districts for Medicare fraud --- especially related to prescription medication.

But medical transport is another area where fraud and abuse is rampant. We’ve discussed the many ways that nefarious ambulance services do their dirt, including:

• Billing for unnecessary routine trips
• Charging for supplies and services that were never provided
• Claiming a higher level of care was provided
• Swapping schemes

So what does this mean for ambulance companies here in NJ?

While prescription medication fraud and opioid abuse might be especially bad here, medical transport fraud is rampant all across the country. Ambulance companies in NJ will be under even more scrutiny with this data analysis program. Any firm that thinks they can get away with the same old business as usual is in for a very rude awakening.

We’ve long been warning of the perils of even trying to go against the rules here on our site, and have documented numerous cases of what happens when you think your company is above the law or won’t ever attract attention.

Sources

Feds roll out new task force to combat Medicare fraud --- NJTV News

Think your Medicare fraud is out of sight? Feds are turning to data and a strike force to find you --- NJ.com