North Carolina is one of many jurisdictions testing new methods to avoid overpaying for Medicare and Medicaid expenses. IBM has developed software that uses predictive analytics to unearth potentially fraudulent Medicaid payments. The fraud detection software analyzes millions of claims for Medicaid eligible patients and looks for billing patterns that have been identified as potentially fraudulent. The goal of the systems is generally to avoid approving improper payments rather than waiting to pursue civil remedies from hospitals, doctors and other health care providers for Medicare or Medicaid fraud after the money has changed hands.
While the troubled economy can certainly be to blame for the multitude of foreclosures and short sales in Florida, at least some of these real estate transactions have involved mortgage fraud.
International drug trafficking cases can be very complex and involve many different parties. Oftentimes, after large-scale investigations, federal prosecutors will bring extensive federal criminal charges against anyone who is suspected of being involved in a drug smuggling conspiracy.
Many times prosecutors in Florida will use evidence of fraud, such as mail fraud or tax fraud, in order to avoid having to prosecute someone on charges that are either more difficult to prove which have less likelihood of a conviction or which cannot be charged in federal court.
The Justice Department began targeting Medicare fraud in 2007 as a national crisis. Since then they have been aggressive in their pursuit and prosecution of anyone they suspect may have been involved in Medicare fraud.
A Ponzi scheme netted a Florida couple some $28 million in profits from 87 victims. The white collar criminal case against the wife has led to a 35 year sentence in federal prison. This despite that fact that her husband, as well as several others recently convicted in similar, larger cases received significantly less prison time. A third person is facing charges in connection with the operation, but he remains outside the country and has yet to be extradicted.