Posted and filed under FWA.

A major case of criminal activity has made its way to the courts, and is a prime example of the importance of auditing medical records.  The work of auditors focusing on fraud, waste, and abuse may often be overlooked by many in the healthcare field – but in many cases, auditors are champions for the law and healthcare community, protecting patients, and even state instituted agencies.

Joshua Miller, a business from New York is now under legal fire after profiting from a very expensive fraud scheme involving a state insurance plan.  Miller’s scam managed to squeeze nearly 2 million dollars from the plan, and presumably had plans to continue the scheme.  Joshua didn’t accomplish this massive task on his own; he managed to involve hundreds of state workers, who unknowingly perpetuated Miller’s fraudulent business enterprise.

Miller, 37, allegedly sold state workers earplugs and earbuds used for sound suppression and cancellation – and reported the sales to the state insurance plan claiming that the earbuds were $3,000 hearing aids.  He made claims to the insurance provider that these earbuds were all medically necessary in order to attain maximum profit for the product.  These hearing aids can cost up to ten times as much as the ear buds he was selling the state workers.

His criminal activity took another turn when it was discovered that Miller paid off a corrections office in order to gain business referrals, thus increasing his profit margins once again.  Billing the state $3,000 per customer racked his bill up to a whopping  $1.6 in just two years.

Miller would have gotten away with it too, if it weren’t for the attention to detail exercised by one manager during an audit – who detected an inordinate amount of deaf workers in the isolated New York area – and reported their findings to the state insurance company – bringing law enforcement in to perform an arrest.

If charged, Miller could be charged with 25 years in prison.