[danans]

If true, $500M of fraud (over only 5 years!) is hard to fathom considering it is a small clinic. I'm wondering how it wasn't discovered before it got to this level. You'd think that even $100M would have set off alarms somewhere.

[coding123]

I recall a few years back on some radio show probably OPB they just started recently to aggregate and chart all of the billing codes from every doctor in the nation, specifically related to medicare billing. It was at that point that they just started to find fraud. So this is a new thing that they can do, and I guess this is one of the outcomes.

I can't wait for them to do this to the military black budget one day.

[jekdoce]

I wonder if they use Palantir software for the analysis?

[qaq]

Why? Outside of Palantir being extremely good at positioning itself as a product and services company vs a consulting shop that they truly are (with obvious significant boost to valuation this gives them).

[HillaryBriss]

interesting that only about $10 million was fraudulently billed to a private company (blue cross/blue shield), and pretty much all the rest was billed to state and federal governments.

maybe this is reading too much into it, but might this be evidence that government health care funds are poorly managed and pay out too much, too often, asking too few questions in the process?

[CPLX]

Or it’s evidence that they exploited a population that doesn’t have private health insurance.

[HillaryBriss]

yeah, that seems reasonable. and maybe the patient population in their area is covered almost exclusively by state and federal plans because of low income.

[_Nat_]

What'd be the argument for that interpretation?

To note it, the article's figures are for submitted claims, not for approved claims.

[HillaryBriss]

true. it may be that they didn't pay out many, or any, of those claims. fair point.