Follow Patrick Linkedin Twitter Facebook
Email Patrick Email
Legal Issues
Dec 15, 2015

Government’s Adoption Of Big Data Analysis Yields Fruit

Sponsored Content provided by Patrick Mincey - Criminal Defense Attorney, Cranfill Sumner & Hartzog LLP

This summer, federal authorities arrested nearly 250 people in a massive bust of alleged Medicare fraud.  The government contends the fraud totaled more than $700 million, and came on the heels of the Department of Health and Human Resources and Office of Inspector General’s report “Ensuring the Integrity of Medicare Part D,” a document which analyzed data from the labyrinth of distribution of billions of dollars for prescription medication.  
 
The popular Medicare Part D program includes annual spending on prescriptions of more than $121 billion annually and has been subject to a spectrum of fraudulent activity. Since its inception, the program has battled with individuals reselling prescriptions and doctor shopping to obtain excessive medication; pharmacies dispensing controlled substances without requisite prescriptions; and prescriber kickbacks. The Office of Inspector General’s report analyzed data to identify areas where fraud was likely occurring so law enforcement could target perpetrators.
 
More than 700 physicians who ordered extremely high percentages of drugs were identified in the report, and pharmacies were cited for errantly filling prescriptions with improper paperwork. Physical therapists, massage therapists and other non-medical providers were also identified as having improperly written prescriptions which were filled.
 
The report lead authorities to conclude that several specific outlets had a high potential for fraud, and investigators ultimately discovered more than a thousand pharmacies billing particularly high amounts of prescriptions at a rate of nearly three times what the average patient receives under the plan. The main type of prescriptions were opiate-based controlled substances. 
 
This is another instance of law enforcement’s integration of big data analysis into investigating corporate fraud. In the past, regulators and prosecutors were limited to pouring over thousands of accounting columns and spreadsheets. Today, tools like AIT’s Comprehensive Financial Investigative Solution allows prosecutors to automatically process paper and electronic documents, record them in a centralized database, and then perform data analysis, graphic visualizations of financial transactional patterns, and fund flows. Agents now have the ability to cut through hundreds of thousands of records, and cases that were at one time dismissed because of the sheer volume and complexity are now viable prosecutions. With recent sweeping policy declarations from the U.S. Department of Justice and other agencies about white collar prosecution, we can expect these types of investigative tools to be used more and more often.
 
Patrick Mincey is a trial lawyer in Wilmington, where he founded the Criminal Defense Group at Cranfill Sumner & Hartzog LLP. His criminal practice ranges from representing individuals and corporate clients who are targets, subjects or witnesses in federal and state white collar proceedings to “blue collar” defendants charged with murder, drug conspiracies and assaults. To contact Patrick Mincey, call (910) 777-6017 or email him at [email protected].

Wbj insights revised 0510 61715110749
Ico insights

INSIGHTS

SPONSORS' CONTENT
Tysonemery

Protect Yourself from Cyber Crime in Real Estate Transactions

Tyson Emery - KBT Realty
Burrus rob headshot 300x300

Are You Blockchain Bound?

Robert Burrus - Cameron School of Business - UNC-Wilmington
Infinity 891835159

Get to Know Infinity Payment Systems

Kyle Thorpe - Infinity Payment Systems

Trending News

Open For Business: New Announcements (Sept. 21)

Johanna Cano - Sep 21, 2018

SBA To Set Up Shop At Wilmington Chamber

Christina Haley O'Neal - Sep 21, 2018

The Future After Flo

Cece Nunn - Sep 21, 2018

Scenes From Hurricane Florence

Michael Cline Spencer - Sep 21, 2018

Health Providers Give Recovery Updates

Ken Little - Sep 21, 2018

In The Current Issue

State Releases Visitor Spending Data

Visitor spending increased in Pender County for 2017, with a growth rate that outpaced Brunswick and New Hanover counties, and even the stat...


MADE: Waking Up The Sleep Market

MADE: Marpac assembles the vast majority of its white noise machines in Wilmington....


WordPress Conference Cancels Due To Hurricane   

WordCamp Wilmington was among the events canceled because of Hurricane Florence....

Book On Business

The 2018 WilmingtonBiz: Book on Business is an annual publication showcasing the Wilmington region as a center of business.

Order Your Copy Today!


Galleries

Videos

2018 Power Breakfast - Dishing on the Restaurant Biz
2018 WilmingtonBiz Expo - Keynote Lunch with Eric Dinenberg, Rouse Properties
2017 Health Care Heroes