With the help of i2 Analyst’s Notebook and iBase, Computer Evidence Specialists (CES) identified and simplified a large healthcare and drug distribution fraud ring and provided the FBI with additional intelligence they needed to secure an indictment.
- Location: United States
- Industry: Healthcare
- Customer: Computer Evidence Specialists, LLC
- i2 Products Used: i2 Analyst’s Notebook and iBase
Computer Evidence Specialists (CES) is a professional firm that provides investigative, intelligence, and analytical services to the U.S. Government, private companies and law firms. CES’s operational expertise lies in the areas of fraud matters, cyber issues and risk concerns.
In early 2011, CES analysts attended a healthcare taskforce meeting where they learned the name “Patel” was suspected to be associated with a large-scale pharmaceutical scheme occurring in Michigan and Florida. Using that minimal amount of data, an analyst at CES began a search in the National Provider Identifier (NPI) registry. The NPI is a registry for healthcare providers, pharmacists, and related figures in the healthcare industry who plan to submit claims for Medicare, Medicaid or private insurance reimbursement. It is the entry point for doing business in the healthcare industry.
Focusing on the Michigan area and searching by the name “Patel”, CES discovered several entries in the NPI database with that name. However, in order to provide law enforcement with enough information to get an indictment, CES needed to develop a better understanding of what these entries were, who and what they were connected to and whether any of these connections were part of a fraudulent scheme.
Solution
CES pulled this information into their own database where they organized the new data and ran it against their existing healthcare data. As they dug deeper, leveraging public information from county healthcare records and the U.S. Department of State, they discovered the name Babubhai Patel was connected to several entries and documents throughout the state. With this information now in one central place, CES continued to search using Patel’s name, adding any match to an i2 chart where they began to visualize Patel’s network. Continuing to dive through the data, CES identified a critical link, one cell phone number that was attached to the various Patel entries. Now they had identified a legitimate and irrefutable connection between these Patel entities and connections.
i2 helps us uncover connections and links between seemingly unrelated entities and clearly visualize those connections so we can equip the law enforcement community with the intelligence and evidence they need to disrupt fraud.
Carl Florez, President, CES
After sharing this information with law enforcement investigators, they further discovered that this same cell number was connected to at least nine pharmacies in the state. Initially, the pharmacies appeared to be owned by various individuals. However, by uncovering the connection between Patel, the cell phone number, and the pharmacies, the investigators now had intelligence that suggested there was more to these pharmacies.
Upon further investigation, CES and the Federal Bureau of Investigation (FBI) determined that the alleged pharmacy owners were connected to Patel and were likely just strawmen intended to mask Patel’s ownership of the pharmacies.
Outcome
CES equipped the FBI with critical intelligence that ultimately led to an indictment by a federal grand jury in Detroit involving 26 individuals who were accused of participating in a large-scale healthcare fraud and drug distribution scheme. In exchange for receiving kickbacks from Patel, participating doctors wrote unnecessary prescriptions for patients, who were also recruited into this scheme with kickbacks, and referred those patients to one of Patel’s pharmacies. Patel’s pharmacies would submit the prescriptions to the insurance agencies for reimbursement even though they never actually filled the prescription, or if they did, they simply gave the pills to the “patient” who would then sell them on the streets.
This scheme involved several players and many layers of transactions. Armed with the intelligence CES created, the FBI was able to simplify this network and provide the grand jury with a clear and concise visual depiction that enabled an indictment.
About CES
Computer Evidence Specialists, LLC is a Veteran’s Affairs verified Service–Disabled Veteran Owned Small Business (SDVOSB) and an SBA-certified minority-owned Small Disadvantaged Business (SDB) founded in 2002 by former FBI executives. They are headquartered in St. Augustine, FL with a satellite office in Rockville, MD serving the National Capitol Region.They are a contractor providing professional investigative, intelligence, compliance, staffing, and training solutions and services to local, state and federal government agencies and commercial companies. CES utilizes the newest and most cost-effective tools and processes to conduct high-quality investigations and intelligence assessments, provide staffing and recruiting solutions and training for its clients and partners.
More information
Find out more about i2 Analyst's Notebook, iBase or contact us to see how we can help you with your healthcare-related investigations.
- US Department of Justice Press Release: Thirteen Individuals Indicted In Health Care Fraud And Drug Distribution Scheme
- Computer Evidence Specialists: Website
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