In the United States began to calculate those who cheat with medical insurance

In college, John Mininho played American football as a defender. After graduation, he worked as an attorney for 18 for years, defending people affected by the medical system. Over the years, he has studied well how health care fraud works.

In the US, part of the cost of medicine is funded through the Medicare medical program. Every year, the state spends 600 billions of dollars on 54 a million people, mostly elderly. According to government estimates, in 2014, 10% of these funds were stolen. From 2007, 2300 clinics and private practices were fined for fraud; 1800 people are brought to justice - for non-obligatory operations, procedures that actually did not turn out, etc.

The state was unable to cope with such a number of violations on its own - the budget cannot pay lawyers for the price of one thousand dollars per hour, as large medical organizations do.

John Mininho judged that you could make money on it. Under American law, an employee can file a lawsuit against an employer who, in his opinion, is involved in a crime, and receive a portion of the amount won by lawyers. Unlike the staff of other offices, Mininho did not wait for the informants to come to him - he began to calculate them himself. Its developers have created a database of thousands of health care system employees from 70 and, through open sources, studied their resumes.

They paid particular attention to well-educated nurses, who worked in one place for only a few months - it was they who, as a rule, became informants. Colleagues Mininho argued as follows: if the nurse quit so quickly, something made her do it.

In the United States, data on all procedures provided by Medicare-funded clinic patients are open. The Mininho company has developed a program for analyzing this data. The algorithm pays attention to unusual patterns. For example, during a snowfall, the number of non-urgent visits to doctors should decrease, however, in some clinics even the snowstorm is provided with the same number of procedures as usual. This oddity may be the reason to start an investigation. Another oddity to pay attention to is when all the patients, regardless of the complexity of the operation, are given the same number of visits by the nurses.

In 2012, John Mininho filed a first suit with one of the clinics with the Ministry of Justice to check the performance of his algorithm. To prepare a complaint, Mininho first found an informant - he was Alex, who worked as a nurse. He said that in his hospital, the management forces the staff to deliver the same number of visits to patients, designed to maximize profits.

As a result, the nurses went to patients who did not need it, without visiting more often those who needed care.

In the middle of 2000-x in the United States, the rule was: for every nine visits to the patient, the clinic received 2200 dollars from the budget; if the number of visits was 10 and more, 2200 dollars were allocated through Medicare. As a result, the distribution of the frequency of visits was abnormal: the staff was five times more likely to have 10 visits than nine. Later, the rule changed - the clinics began to pay extra for 14 visits, and the peak immediately shifted to this mark.

Now, according to the lawsuit of Mininho, a pre-trial agreement is being prepared.

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