Healthcare fraud is billing a health plan, Medicare or Medicaid for care that was never given, was not needed, or was dressed up to look more expensive than it was. Patients pay for it in higher premiums, and sometimes in treatment they did not need.
Most cases start with a pattern in the billing data that does not fit: a clinic billing more hours than exist in a day, or one doctor ordering far more of a test than everyone else. Others start with an employee who sees it from the inside and reports it.
From there, agencies like HHS-OIG and the DOJ pull records, interview patients and staff, and follow the money.
Cases Barry and Titus worked themselves, with where each one stands. See every Case File.
Federal prosecutors charged Paul Regan with taking more than $60 million from over 300 investors through Next Level Holdings and Yield Wealth Ltd. Investors lost more than $50 million.
Federal prosecutors charged Paul Regan with selling about 300 “protected” notes through Next Level Holdings, taking in more than $45 million and paying old investors with new investors’ money.
Federal authorities charged Marco Santarelli with orchestrating a $62.5 million Ponzi scheme through Norada Capital Management.
Every healthcare Fraud File breaks down how the scheme worked, who caught it and what it cost. Read the healthcare Fraud Files.
