Tag Archives: healthcare fraud

Where Some Of Our Tax Money Has Gone

Posted on by

On Saturday, Townhall posted an article about a recent federal court case in Central Islip, New York.

The article reports:

Two people were indicted earlier this week in federal court in Central Islip on charges of committing healthcare fraud and conspiracy to defraud the U.S. 

Saad Aziz, 52, of New York, and Zabed Chowdhury, aka “Jared,” 49, of Lake Ronkonkoma, New York, were charged with conspiracy to commit healthcare fraud, health care fraud, conspiracy to defraud the United States and pay healthcare kickbacks, paying health care kickbacks, and money laundering conspiracy.  

The defendants allegedly offered and paid healthcare kickbacks and submitted fraudulent claims to Medicaid for ambulette services to medical appointments that were not performed, or the costs were artificially inflated.  

The defendants were previously charged by complaint and will be arraigned at a later date.

The article notes:

The defendants also systematically inflated their Medicaid reimbursements.  Although numerous addiction treatment centers on Long Island were available to beneficiaries, the defendants directed beneficiaries to request transportation to addiction treatment centers in New York City and to provide false pickup or drop-off addresses so they could bill Medicaid for longer, more expensive trips.  Through this scheme, the defendants submitted more than $18 million in claims for rides exceeding 75 miles and, overall, fraudulently billed Medicaid more than $35 million.

…If convicted of the charges, the defendants each face up to 20 years in prison, and restitution and forfeiture of at least $35 million, including several real properties and 15 bank accounts.

The article concludes:

The government’s case is being handled by the Criminal Section of the Office’s Long Island Division.  Assistant United States Attorney Adam R. Toporovsky is in charge of the prosecution, with assistance from Paralegal Specialist Janelle Robinson.  Assistant United States Attorney Madeline O’Connor of the Office’s Asset Forfeiture Section is handling forfeiture matters.

On April 7, 2026, the Department of Justice announced the creation of the National Fraud Enforcement Division (Fraud Division). The Fraud Division is focused on investigating and prosecuting those who commit fraud against the American people.

How much taxpayer money could be saved by better oversight of benefit spending?

The Health Care Heist

Posted on by

On Wednesday, PJ Media posted an article about the biggest health care heist in American history. The heist was discovered thanks to the efforts of the Department of Government Efficiency (DOGE), artificial intelligence (AI), and basic law enforcement techniques.

The article reports:

If you didn’t hear about the bust of 324 people; the U.S.-based cartel shell medical supply companies; the pill mills pushing opioids; the doctors on the take; or how law enforcement captured many of the bad guys at the U.S. border and airports as they rushed to escape, that’s understandable. The feds revealed this potential $14.6 billion “depth charge” planted inside the Medicaid, Medicare, and private insurance programs in June, while most people were away on summer vacation.

Why did transnational organizations go after these particular programs? “Criminals go where the money is,” Acting Health and Human Services Inspector General,Juliet Hodgkins said at a news conference about “the largest health care fraud takedown in American history.” There’s more than $1.4 trillion spent by these government programs per year, and the bad guys have tried, by hook or by crook, and even with the aid of AI, to set into motion plans to steal nearly $15 billion. They got away with just shy of $3 billion before they were caught, and their other frauds were frozen in their tracks.

If this bust looks to you like it had Elon Musk’s old Department of Government Efficiency fingerprints on it, you’d be right. Using AI and law enforcement tactics, the DOGE team worked with HHS, the Center for Medicare and Medicaid, and an all-hands-on-deck array of federal agents from the DEA, FBI, and health care agencies to track down all fraud leads, according to Dr. Mehmet Oz, head of the Centers for Medicare and Medicaid Services (CMS). As a result, the feds are setting up a healthcare data fusion center to detect where fraud spikes are occurring in near real time.

The article concludes:

Other scams used a network of Phoenix-based sober living houses to demand government payments for people who never got addiction treatment at the facilities. The facilities, run by ProMD, received $560 million before the feds caught on to the scam.

In Atlanta, medical professionals ordered skin grafts for dying patients who didn’t need them. By the time the grift was discovered, they’d scammed Medicare out of $760 million.

People from as far away as Estonia have been arrested. Seven people were found trying to scuttle over the southern U.S. border but were stopped before they got away. Another bunch were caught trying to leave the country from U.S. airports.

The bad actors from Russia, Pakistan, and Eastern Europe used the American health care system like their “personal piggy bank,” the Department of Justice’s Acting Criminal Division leader, Matthew Galeotti, said. He said that “this was a staggering breach of trust” and they “will prosecute these criminals as aggressively as we would any drug dealer because that’s exactly what they are.”

Musk, who stepped away from the White House after a rift with President Donald Trump, is the one who conceived and executed the DOGE project, and he’s a damned American hero. Let’s give that guy a medal for saving American taxpayers yet another tranche of billions.

All of this fraud was paid for by the American taxpayers.

Taking Action Against Medical Fraud

Posted on by

On Friday, The Gateway Pundit posted an article about the Department of Government Efficiency’s (DOGE) next target.

The article reports:

Elon Musk, who is leading the charge under President Trump’s newly established Department of Government Efficiency (DOGE), announced on his social media platform X that the Centers for Medicare and Medicaid Services (CMS) wasted a staggering “$100 billion of taxpayer money.”

On Wednesday, Musk’s team, along with two senior veterans from the agency, has been meticulously reviewing the CMS’s payment and contracting systems, which are crucial for managing health insurance for approximately one in every four Americans, according to far-left USA Today.

“CMS has two senior Agency veterans – one focused on policy and one focused on operations – who are leading the collaboration with DOGE, including ensuring appropriate access to CMS systems and technology,” the agency said in a statement to Reuters.

The DOGE team was granted read-only access to the system.

The article concludes:

Medicare currently covers about 68 million Americans, primarily those over 65 and individuals with disabilities, while Medicaid serves approximately 73 million low-income citizens.

According to the Centers for Medicare & Medicaid Services (CMS), from June 2024 through October 2024, CMS suspended 850 agents and brokers’ Marketplace Agreements for reasonable suspicion of fraudulent or abusive conduct related to unauthorized enrollments or unauthorized plan switches. These agents and brokers are now prohibited from participating in Marketplace enrollment, including receiving related commissions.

The Department of Justice has also been active in combating healthcare fraud.

In recent years, the average loss associated with the schemes prosecuted by the Health Care Fraud Unit has steadily risen.

In June 2024, the Department of Justice announced charges against 193 defendants, including 76 medical professionals, for their alleged involvement in fraudulent schemes amounting to approximately $2.75 billion in false claims.

Since 2007, the Health Care Fraud Unit has charged more than 5,400 defendants with fraudulently billing Medicare, Medicaid, and private health insurers more than $27 billion.

It’s amazing what young computer wizards can find!