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Clinic owner conceals $3.3 Million in Medicare fraud

The Office of the Commonwealth Director of Public Prosecutions
Date published
October 2018

Relevant impacts: Financial impact, reputational impact, industry impact and business impact

A medical clinic owner defrauded the Commonwealth of more than $3.3 million by claiming rebates for services not given to over 5,870 different patients. He deleted the claims from the clinic's practice management software shortly after submitting them in order to avoid detection from employees and health practitioners of the clinic. The investigation was commenced when several members of the public made enquiries about their claim history for services they had neither sought nor received. The man pleaded guilty to 6 charges of fraud under the Criminal Code 1995 (Cth) and was sentenced to 6 years in prison.

Related countermeasures

Reconcile records to make sure that two sets of records (usually the balances of two accounts) match. Reconciling records and accounts can detect if something is different from what is standard, normal, or expected, which may indicate fraud.

Audit logging is system-generated audit trails of staff, client or third party interactions that help with fraud investigations.

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