There are many fraud schemes unscrupulous medical providers use to trick insurance companies out of thousands, and even in some cases, millions of dollars. According to the FBI’s Financial Crimes Report, billing for services not rendered is one of the most prevalent types of healthcare fraud.
Law Enforcement requested The National Insurance Crime Bureau’s assistance investigating the alleged fraudulent billing practices of an Illinois Orthopedic Surgeon. NICB Special Agent Joseph Barrera teamed up with the Office of the Inspector General for this investigation.
“We decided it would be a good idea to combine our investigation and NICB would take the liaison role with the insurance side because we could work directly with our member companies,” Special Agent Barrera said.
Special Agent Barrera, along with agents from the FBI, DEA, HHS, and OIG, spent countless hours on the joint investigation.
Thanks to cross-collaboration, the Orthopedic Surgeon was indicted in the United States District Court on 19 counts of insurance fraud.
The NICB worked with the Federal Bureau of Investigation, U.S. Postal Inspection Service, Illinois Department of Labor, Illinois Office of the Inspector General, Drug Enforcement Administration, U.S. Food and Drug Administration, and multiple-member company Special Investigation Units on this case.
Special Agent Barrera says this is a great example of how NICB partners with multiple agencies and our member companies to combat insurance crime.