RECENT NEWS
The Medicaid Corrupted Provider Loop
In a scheme mirroring the “corrupted retailer” scheme seen in SNAP, fraud in Medicaid is on a massive scale; transnational criminal organizations (TCOs) partner with or establish dishonest medical providers and durable medical equipment provider (DME) companies, or diagnostic laboratories.
The corrupt provider submits electronic claims stating they performed complex genetic testing, physical therapy, or telemetry monitoring on hundreds of synthetic ghost patients…
CMS’ recent push for states to revalidate high-risk Medicaid providers is a clear signal: program integrity scrutiny is increasing
CMS’ recent push for states to revalidate high-risk Medicaid providers is a clear signal: program integrity scrutiny is increasing.
As states work to meet these expectations, Medicaid managed care organizations may be asked to support significant provider validation activity, including site inspections, licensure verification, and operational reviews…
Telehealth and “Digital Injection” Anomalies
The explosion of telehealth has eliminated the need for physical, face-to-face interaction, providing the perfect cover for synthetic networks.
When state auditors or MCO compliance teams implement automated liveness or identity-verification protocols to confirm that a patient actually exists before authorizing high-dollar treatments, syndicates deploy the exact same digital injection attacks used to beat enrollment portals…
