General practitioner jailed for Medicare fraud
Date published
May 2018
Relevant impacts: Financial impact and reputational impact
A general practitioner made 2,349 Medicare claims for services he did not provide. These false claims were submitted over a two year period and defrauded Medicare of $175,266. The investigation was commenced when his colleagues raised the alarm about potential false billing with the Department of Human Services. The man pleaded guilty and was sentenced to 3 years in prison.
Related fraudster personas
Related countermeasures
Verify any requests or claim information you receive with an independent and credible source.
Make sure sensitive or official information cannot leave your entity's network without authority or detection.
Automatically notify clients or staff about high-risk events or transactions. This can alert them to potential fraud and avoid delays in investigating and responding to fraud.
Put in place processes for staff or external parties to lodge tip-offs or Public Interest Disclosures.
Reconcile records to make sure that 2 sets of records (usually the balances of 2 accounts) match. Reconciling records and accounts can detect if something is different from what is standard, normal, or expected, which may indicate fraud.
Audit logging is system-generated audit trails of staff, client or third-party interactions that help with fraud investigations.
Submit a case study
We'd like to hear from you if you have a case study to share.