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Anti–Fraud Case Files

Our Corporate & Financial Investigations Department identifies, investigates, and seeks prosecution on internal and external fraud. We partner with state and federal law enforcement and regulatory agencies and other insurance companies in the fight against these crimes.

Health care fraud is a violation of state and/or federal law. Under federal law it is a felony offense (18 USC 1347), punishable by a fine of up to $250,000 and/or up to ten years’ imprisonment. If the violation results in serious bodily injury, up to a 20–year prison term is possible.

Sample cases of successful fraud prosecution

  • Case #1 — Owner/Operator of a Durable Medical Supply Company (DME Supplier) was convicted of 143 counts of healthcare fraud, mail fraud, and paying illegal kickbacks for Medicare referrals. The owner/operator was sentenced to 66 months in federal prison.
  • Case #2 — Pharmacist sentenced to 10 years in prison for conspiracy and distribution of controlled substances relating to the filling of “sham prescriptions” for Percocet, Xanax, and Lorcet in exchange for cash and other benefits.