First, this news item, from the BBC:
91 people and around $300 million in fraud. Once again, Miami seems to be epicenter of the problem, with about half of the arrests taking place there. If the news items are correct, these allegations represent outright fraud and theft of money, not disputes over disparities between levels of service provided and billed for. The former is uncontroversial, the later is and will continue to be a huge headache for honest practitioners.
In this instance, there were arrests in the Chicago area:
Please note: bills were apparently paid for services rendered to dead people. This is not quite as odious as it sounds, as the modern world of medical billing can create a substantial delay between the time a service is provided and the bill for it is generated.
How does this happen? Well, this story is informative:
So, a total of 41 people are tasked with ferreting out something like 60-90 billion dollars in fraud. First, it is hard for me to imagine that there is that much fraud out there. Suppose it was only $6 billion. Suppose you had your full complement of 600 investigators. That's $10 million in fraud per investigator per year - there is at least the potential for a huge return on your investment. Only the Feds could underinvest on this scale.
And for those of you who are interested in the NHS IT saga from across the pond, I point out this news item:
The article is replete with statements about the substantial sums that have already been spent, and the the real-world frustrations to implementing this apparently 'good' idea. Outsiders have a hard time imagining what the problem. Anyone with any real familiarity with these systems has a hard time imagining any other outcome.