July 1, 2011

Medicare Wins in Vegas Fraud Case

Rakesh Nathu, a Las Vegas oncologist, settled his fraud case with the Justice Department yesterday for $5.7 million plus interest. Dr. Nathu was accused of submitting false claims to Medicare, TRICARE and the Federal Employees Health Plan for various radiation oncology services, including intensity modulated radiation therapy, and double billing for services. We hope he did better at the craps table. The government has recovered more than $7.3 billion in False Claim Act cases since 2009.

Among CarePrecise clients are law enforcement agencies working on federal and private payer fraud investigations. As a result of work done for our clients, we developed a means of matching the federal fraud conviction list with providers' NPI records, and associating certain demographic data with practice locations to help visualize patterns. Late in 2010 we began including the fraud data in our CarePrecise Access Complete dataset, and the additional economic data in CarePrecise Gold products. Now included is a flag that indicates provider records whose data strongly suggest a match with the federal LEIE (List of Excluded Individuals/Entities) database. Other features help investigators track providers' licensing, credentials, specialty codes, enrollment in the PECOS database, and numerous other functions.

Read the Justice Department news release.

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