Duff Wilson: Investigating health care fraud
Duff Wilson, an investigative reporter at The New York Times, detailed the anatomy of a health care fraud investigation and pointed reporters to useful Web sites and resources as part of the "Master class in health care fraud" at Health Journalism 2009. He also included resources in his PowerPoint presentation.
- Start with a new idea.
- Competitors. Whistleblowers. Doctors. Patients.
- Federal and state law enforcement.
- Personal injury lawsuits and discovery materials.
- Securities and Exchange Commission filings and business lawsuits.
- Public records through FOIA, state record laws, CFR and state regulations.
- Investigate somebody: Who is John Doe? http://www.reporter.org/desktop/tips/johndoe.htm
- Journals, studies, press articles.
Pharma - helpful Web sites and blogs:
- Cafe Pharma http://www.cafepharma.com
- WSJ Health Blog http://blogs.wsj.com/health
- Carlat Psychiatry Blog http://carlatpsychiatry.blogspot.com
- Peter Rost, former Pfizer VP / whistleblower http://peterrost.blogspot.com
- Shearlings Get Ploughed http://shearlingsplowed.blogspot.com
- Drugwonks - Center for Medicine in the Public Interest http://www.drugwonks.com
- Prescription Project http://www.prescriptionproject.org
- Furious Seasons (psych) - http://www.furiousseasons.com
- PharmedOut http://www.pharmedout.org
Health care fraud - helpful Web sites:
- AHCJ - http://healthjournalism.org
- Investigative Reporters and Editors - http://www.ire.org
- HealthNewsReview - http://www.healthnewsreview.org
- Health Care Fraud Blog (Fla. atty) - http://www.healthcarefraudblog.com
- Health Care Law Blog - http://healthblawg.typepad.com
- Corporate Crime Reporter (white collar D) - http://www.corporatecrimereporter.com
- HHS Office of Inspector General - http://www.oig.hhs.gov http://oig.hhs.gov/fraud/enforcementactions.asp
- U.S. Government Accountability Office - http://www.gao.gov
- HHS Office of Human Research Protections - http://www.hhs.gov/ohrp/compliance/letters
- False Claims Act (qui tam whistleblowers) - http://www.usdoj.gov/opa/pr/2008/November/fraud-statistics1986-2008.htm Also http://www.usdoj.gov/opa (search qui tam health)
- CRISP (Computer Retrieval of Information on Scientific Projects) is a searchable database of federally funded biomedical research projects) http://crisp.cit.nih.gov/
- ARCOS (DEA Automation of Reports and Consolidated Orders Systems) is an online database of the production and distribution of controlled substances to pharmacies and health providers. http://www.deadiversion.usdoj.gov/arcos
- EthicSolutions LLC: Consulting firm that assists law firms and the federal government with civil and criminal health care fraud cases
- John W. Schilling: licensed CPA with 18 years of health care financial experience. Confidential undercover informant and a key witness in the FBI probe and subsequent prosecution of Columbia/HCA, resulting in a civil settlement of more than $1.7 billion. Currently a partner with EthicSolutions LLC.
- The Flex Monitoring Team monitors and evaluates the Medicare Rural Hospital Flexibility Grant Program (Flex Program).
- Critical Access Hospitals program, designed to improve rural health care access and reduce hospital closures.
- Taxpayers Against Fraud
- Centers for Medicare & Medicaid
- Healthcare Financial Management Association
- Association of American Medical Colleges
- National Health Care AntiFraud Association
- Canadian Health Care Anti-fraud Association
- Association of Certified Fraud Examiners
- HHS Office of Inspector General search for excluded individuals/entities
- American College of Healthcare Executives
- American Hospital Directory: Company that collects and offers data about hospitals, including CMS public use files, cost report data, Medicare cost reports and claims plus a range of proprietary data.