Stopping provider fraud
Proactive data analysis demonstrated that a New York surgeon, Dr. Syad Imran Ahmed, billed patients in the hospital on an almost daily basis for incision and drainage services in the operating room that were never received. Investigators developed a case which was referred to the Office of Inspector General (OIG) and accepted for criminal investigation.
A declaration from the OIG stated, “Based upon the information provided to OIG by SafeGuard Services and OIG’s investigation, OIG uncovered credible information that from January 1, 2011 to the present, Dr. Syed Imran Ahmed submitted fraudulent claims from payment to the Medicare program in the amount of $88M submitted, $7.5M paid.”
This provider was arrested and convicted of one count of health care fraud, three counts of making false statements related to health care matters and two counts of money laundering and sentenced.