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Tips for Law Enforcement Investigating Affordable Care Act Scams

by Kim Williams  -   March 12, 2014

The complexity and newness of the Affordable Care Act (ACA) create challenges for law enforcement. Compounding the situation is the fact that many perpetrators are using the Internet to facilitate their crimes, which allows them to operate from anywhere and makes it easier for them to remain anonymous.

Investigators can arm themselves against these criminals, however, by understanding both the Affordable Care Act and the resources available to them. The ACA includes several new measures aimed specifically at curtailing fraud, waste and abuse. Some of the measures include:

  • Stiff new rules and sentences for health care fraud offenses: ACA increases the federal sentencing guidelines for health care fraud offenses by 20%-50% for crimes involving more than a million dollars in losses. It also establishes penalties for obstructing a fraud investigation or audit and makes it easier for the government to recapture funds acquired through fraudulent practices.
  • Improved coordination of fraud prevention efforts.
  • Implementation of fraud detection technology.
  • Enforcement funds: $350 million is earmarked to be dedicated to ramping up anti-fraud efforts, including scrutiny of claims before they’ve been paid, investments in data analytics and dedicating more law enforcement agents to the fight against fraud in the health care system.

A resource available for state and federal law enforcement is the Federal Trade Commission’s Consumer Sentinel Network database. This database allows monitoring of fraud complaint activity within all 50 states and is used to track potential fraud activity. For more information, visit http://www.ftc.gov/sentinel/.

In addition, law enforcement officers may reach out to their communities, sharing prevention tips through speaking engagements, blog posts and other social media postings. A proactive approach may give citizens the information they need to avoid victimization.

NW3C’s research section has prepared white papers examining issues relevant to law enforcement who investigate crimes related to health care, and specifically to the ACA. These papers are available online at: 

NW3C also offers a course that provides investigators with training related to identity theft. For information and to register, please visit http://www.nw3c.org/training/financial-crimes/29.

Image copyright information:
Thumbnail: Copyright Naypong, 2014 Used under license from Shutterstock.com
Larger image: Copyright Christian Delbert, 2014 Used under license from Shutterstock.com

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