How to Check if a Healthcare Company Has Been Charged with Fraud
How to Check if a Healthcare Company Has Been Charged with Fraud
Healthcare fraud is a huge problem that costs taxpayers billions of dollars every year. From billing scams to kickbacks to falsifying records, shady healthcare companies use lots of schemes to illegally profit off patients and government programs.
So how can you check if a healthcare provider has been caught up in fraud? There’s a few ways to research a company’s background and see if any red flags pop up. This article has tips to help you spot healthcare fraud charges.
Search the Office of Inspector General Website
The Department of Health and Human Services Office of Inspector General (OIG) is the main agency that investigates Medicare and Medicaid fraud. They maintain a few databases you can search to find fraud cases:
- OIG’s List of Excluded Individuals and Entities – Database of people and companies banned from federal programs due to fraud, patient abuse, etc.
- Most Wanted Fugitives List – People evading law enforcement for healthcare fraud crimes.
- Medicare Fraud Strike Force Cases – List of recent fraud takedowns in strike force cities.
Dig into these resources to see if any cases involve the company your researching. Red flags include owners, doctors, or executives being excluded for past fraud.
Look Up Criminal Records
Another place to check is criminal record databases which compile fraud convictions across all courts. Paid services like Instant Checkmate or TruthFinder let you search for convictions under a company or person’s name.
Fraud charges are often felonies prosecuted in federal court. So broad databases capture these cases that a state search might miss.
Search News Articles and Press Releases
When a major fraud bust happens, there’s usually news coverage and government press releases. Search engines like Google and press release distribution sites can turn up these stories.
Try searches like “[Company name] fraud” or “[Doctor’s name] medicare fraud” to find relevant articles. Press releases may come from the Department of Justice, FBI, or other investigating agencies.
Look for Whistleblower Lawsuits
Many fraud cases originate from whistleblower complaints filed under the False Claims Act. These lawsuits are public record, though sometimes sealed temporarily.
Search federal court records for qui tam or FCA suits against the company. PACER offers a database to lookup cases by company or individual name.
Check State Licensing Boards
If dealing with licensed professionals like doctors, nurses, or pharmacists, check if their state licensing board has taken any disciplinary actions for fraud.
Most state boards offer license lookups where you can view actions against the licensee’s record. This may turn up reprimands, restrictions, or revocations for fraud.
Look for Unusual Patterns in Data
Government healthcare data can also provide clues to potential fraud. Unusual patterns in Medicare billing data or prescription records may indicate issues. For example:
- Drastic increases in services billed from one year to the next
- Billing extremely high volumes of certain procedures compared to peers
- Prescribing large quantities of controlled substances
Now raw data alone doesn’t prove fraud. But it can help flag providers for a closer look.
Consult Online Reviews
Patients complaining about suspicious billing practices or other shady behavior in online reviews may indicate problems. Search for the company on Google, Yelp, and other review sites.
Of course take negative reviews with a grain of salt. But multiple consistent complaints around fraud raise a red flag.
Follow Your Instincts
If something just feels “off” about the provider, don’t ignore that instinct. Questionable marketing, pushy sales tactics, or too-good-to-be-true claims could be signs of trouble.
Do your homework before entrusting healthcare services or billing to any organization. A bit of upfront research could save you major headaches down the road.