Fraudsters are now stealing the identity of doctors to defraud millions from Medicare, Medicaid and other insurance carriers. The widespread use and distribution of physician identifier numbers makes it easy for thieves to steal the identity of doctors and bill insurers in the doctor’s name. There are two main approaches to using a doctor’s identity to commit fraud. In the first they make it appear that the doctor has referred patients for services such as lab analyses, diagnostic testing or prescribed durable medical equipment. In the other approach, the fraudster used the physician’s id to bill directly for services in the physician’s name, as if the services actually were rendered by that doctor.
The Centers for Medicare and Medicaid Services (CMS) has a new program that tracks Medicare physician and beneficiary id numbers that are flagged for fraud investigations due to reports of security breaches, doctor or patient complaints. This allows CMS investigators to identify “hot spots” which currently include Los Angeles, New York and Miami.
Linda Webb, leading fraud expert, aka, the FRAUD DOG says we can all help to stop this fraud by reviewing the “explanation of benefits” notices from payers to spot patient and physician identity theft and reporting them. Always look to see that you received the service or equipment on the date listed and by the physician listed. If you have any questions call the insurance company immediately.
If you are seeking fraud investigation services, contact Contego Services Group today. With the leadership of seasoned fraud investigator Linda Webb, Contego has a solid track record for catching criminals involved in tax fraud, insurance fraud, medicare fraud and all other types of fraud crime. For more information, call 1-855-WE-SWARM today.