CES

Fraud in the United States

admin — Tue, 10 Jan 2012 21:58:51 +0000

CES is pleased to announce the release of the inaugural 2011 Report on the Cost of Fraud in the United States. This report represents the culmination of months of research and analysis. It begins by breaking fraud down into six categories: corporate, securities, financial, mortgage, healthcare, and insurance fraud. The report then analyzes publicly available data on those subjects and reports on the dollars lost to that particular form of fraud, the common schemes used by perpetrators, and what is being done to combat fraud.

CES’ fraud report is based on the United Kingdom’s “Annual Fraud Indicator,” which reports on similar losses associated with fraud. Surprisingly, this report is one of the first times that an organization was able to place a total figure on the losses associated with fraud in the United States. CES’ ultimate goal is to ensure that this number is tracked annually with a higher degree of precision than what currently exists.

Ultimately, the report is intended to give the reader insight into America’s fraud problem. It is not a guide to preventing fraud where it occurs. Rather, it represents a starting point: the identification of the issue. It is an assessment of the obstacles that must be overcome to eventually reduce the losses associated with fraud. The insight gained from this report should be used to take the next step: working to lessen America’s exposure to fraud.

CES welcomes any comments, questions, or feedback on the report itself. The report itself is available in .pdf version. If you would like a printed copy, please request one at: here. Send an email, and we will mail one to your given address.

26 Indicted in Drug Distribution Investigation

admin — Sun, 18 Sep 2011 22:43:54 +0000

“Babubhai “Bob” Patel, 49 (pictured), a Canton pharmacist, was the beneficial owner and controller of some 26 pharmacies statewide (referred to in the indictment as “the Patel Pharmacies”). Babubhai Patel concealed his ownership and control over many of the Patel Pharmacies through the use of straw owners. The indictment alleges that Babubhai Patel would offer and pay kickbacks, bribes, and other inducements to physicians, in order to induce those physicians to write prescriptions for patients with Medicare, Medicaid, and private insurance, and to direct that those prescriptions be presented to one of the Patel Pharmacies for billing. In exchange for their kickbacks and inducements, the medical professionals would write prescriptions for the patients, and bill the relevant insurers for services supposedly provided to the patients, without regard to the medical necessity of those prescriptions and services. The physicians would direct the patients to fill their prescriptions at one of the Patel Pharmacies. There, according to the indictment, Babubhai Patel and his pharmacists would bill insurers, including Medicare, Medicaid, and private insurers, for dispensing the medications, despite the fact that the medications were medically unnecessary and/or never provided. Patients were recruited into the scheme by patient recruiters, who would pay kickbacks and bribes to patients in exchange for the patients’ permitting the Patel Pharmacies (and the physicians associated with Patel) to bill their insurance for medications and services that were medically unnecessary and/or never provided.”

Indictment | Press Release

Fraud in the United States

admin — Sun, 18 Sep 2011 15:04:54 +0000

Fraud in the United States is a systemic problem. It results in trillions of dollars in losses each year to all segments of society. Individuals, corporations, and all forms of government fall victim to a variety of fraudulent schemes because overarching trends and patterns in fraud are not being thoroughly examined. The inability to accurately measure fraud across a broad spectrum results in uneven and ineffective enforcement of anti-fraud measures.

In CES’ first annual report on fraud in the United States, we will detail the extent of fraud by comprehensively examining six broad categories. The report will look at popular schemes and trends, common perpetrators, and most importantly, we will attempt to put a number on the total amount of losses associated with fraud. We expect that the report will help shine a brighter light on how big of a problem that fraud has become in our society.

This report differs from other existing fraud reports since it provides an estimate on the total losses incurred as a result of fraud, not just the losses associated with a single category, such as insurance fraud. The report is modeled after the “Annual Fraud Indicator” released by the British National Fraud Authority. Our research was compiled from a variety of public sources with an emphasis on using federal sources when available. It is our hope that the report spurs greater efforts in both the public and private sectors to research the impacts of fraud on our society and develop methods to detect and prevent it in the future.

Miami Man Indicted for Healthcare Fraud in Gainesboro, Tennessee

admin — Sat, 17 Sep 2011 15:07:56 +0000

On September 23, 2010, Yennier Capote-Gonzalez of Miami, Florida, was indicted in the Middle District of Tennessee in Nashville for engaging in health care fraud, money laundering, and aggravated identity theft. Mr. Capote-Gonzalez established a phantom infusion clinic, Gainesboro Ultimate Med Services in Gainesboro, Tennessee (pictured), in order to submit fraudulent Part C claims to WellPoint and CIGNA for J-codes using legitimate numbers of an unsuspecting Medicare provider and beneficiaries. The total amount billed by Mr. Capote-Gonzalez to WellPoint and CIGNA was $205,965. The total amount paid by CIGNA Health Plan was $38,116.
WellPoint Plan had no monetary loss.

Indictment | Press Release