December 07, 2019

Big Data as a Big Source of Healthcare Fraud Prosecutions – and Defenses

By Jason Mehta, Esq., Bradley Arant Boult Cummings, LLP, Tampa, FL

As most healthcare providers know, hardly a day goes by without the Department of Justice (DOJ) announcing a new flashy healthcare fraud settlement or conviction.  And many of these splashy press releases explicitly cite the use of data and data mining as a way of identifying and prosecuting the alleged wrongdoer.1

In fact, even when it comes to the healthcare crisis du jour — the opioid crisis — the DOJ proudly boasts of its data-mining efforts.  As former Attorney General Jeff Sessions barnstormed across the country promoting the DOJ’s opioid initiative last year, he developed a standard stump speech.  In that often-repeated speech, he proudly promoted a new DOJ initiative known as the Opioid Fraud and Abuse Detection Unit, a new data analytics program that focused on opioid-related healthcare fraud. In his words, this unit was using data and data-mining techniques in order to “tell us important information – who is prescribing the most drugs, who is dispensing the most drugs, and whose patients are dying of overdoses.”2  

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