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
Tidewaterinvestmentco merrettemoore headshot

It Is Time To Hit The Road To Find Some Private Company Opportunities

Merrette Moore - Tidewater Investment Company
David webversion headshots march21 8172134246

10 STEPS TO PREPARE YOUR FACILITY FOR HEAVY STORMS

David Grandey - Highland Roofing Company
Mel profilephoto

Influencer Marketing: Tap Into Your Audience On A Budget

Mel Beasley - Wide Open Tech

Trending News

Restaurants, Retailers Among 192 Businesses Receiving Pandemic Relief Grants

Staff Reports - Sep 22, 2021

Mayfaire Announces Opening Dates For New Stores

Cece Nunn - Sep 21, 2021

More Than 51 Acres Sell In Leland

Cece Nunn - Sep 21, 2021

New Restaurant Opening Saturday In Ogden

Justin Pope Williams - Sep 22, 2021

Custom Builder Moves Into New Office After Repurposing Former Church Building

Cece Nunn - Sep 23, 2021

In The Current Issue

MADE Winners: Exporter Category

HSM Machine Works, Marpac Yogasleep and SOS Life Sciences Corp. were winners in the MADE Awards Exporter Category....


MADE Winners: Arts Category

Filmwerks, House of Harris and T. Shaw Designs were winners in the MADE Awards Arts Category...


MADE Winners: Manufacturer Category

Cape Fear Catamarans, CDB Corp. and Mojotone were winners in the MADE Awards Manufacturer Category....

Book On Business

The 2021 WilmingtonBiz: Book on Business is an annual publication showcasing the Wilmington region as a center of business.

Order Your Copy Today!


Galleries

Videos

Trying to Grow a Business?
2020 Health Care Heroes
2020 WilmingtonBiz 100