Investigating Health Care Fraud

With millions, even billions, of dollars in Medicaid and Medicare fraud committed each year, state and federal officials have set ambitious goals to find and prosecute more financial crimes.  But investigators say they need tougher law enforcement tools to effectively and safely do their job.

Randall Clouse, Section Chief for the Attorney General, says perpetrators are becoming more sophisticated and dangerous. “Last year, we convicted a nontypical organized crime ring which was Russians that came over to this country and set up an in-home health care company—and fraudulently billed to the tune of about $7-million. We convicted them in federal court.”

The  medical fraud control unit must ask law enforcement officers to serve subpoenas and warrents, and seize evidence, but Clouse says investigators are seeking law enforcement authority, which would include carrying arms and badges, because suspects may have drugs or guns.

The Virginia Crime Commission will make a recommendation to lawmakers later this year.

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