More than a dozen health care professionals in North Texas are accused of submitting hundreds of millions of dollars in false and fraudulent health care claims.
More than a dozen health care professionals in North Texas are accused of submitting hundreds of millions of dollars in false and fraudulent health care claims.
Physicians, nurses and other health care workers face an array of federal charges, from conspiracy to commit fraud to offering and accepting bribes. The charges are part of a sweeping federal investigation announced Tuesday that has led to charges against about 450 people, including 90 physicians, nationwide. Authorities say the fraudulent claims totaled $6.5 billion nationwide.
In North Texas, authorities say they have identified $365 million in fraudulent and false claims and have seized more than $35 million in cash, luxury vehicles and other assets.
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MANAGEMENT & CULTURE (THE “TONE AT THE TOP”)
Fraud thrives in “sloppy” environments where leadership ignores the rules.
- The Fraud Triangle: For fraud to occur, three elements must be present: Pressure (the need for money), Rationalization (thinking “I deserve this”), and Opportunity (weak controls). You can only control the Opportunity.
- Whistleblower Hotline: Provide an anonymous way for staff to report “odd behavior.” Most internal frauds are caught via tips, not audits.
- Background Checks: Conduct credit and criminal record checks for all employees in financial or data-sensitive roles.
- Annual Ethics Training: Make sure every staff member knows that the company has a Zero Tolerance policy toward “borrowing” from petty cash or fudging overtime.