How fraud detection helped cap $2B Medicare scheme at $5M

Medicare fraud schemes targeting durable medical equipment (DME) providers pose a growing threat, with operations generating billions in fraudulent claims across jurisdictions.

This case study shows how advanced fraud detection systems mitigate large-scale Medicare fraud through comprehensive monitoring. Key findings include:

• Five DME providers in different states linked via shared payment systems
• Specialized monitoring flagged suspicious patterns missed by traditional systems
• Notifications and payment controls capped losses at $5M, while the scheme reached $2B

Learn how robust fraud detection protects against sophisticated Medicare schemes.