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Middle Tennessee Federal Criminal Defense Law Blog

AI and analytics may help to reduce health care fraud

In 2016, many people in Tennessee were shocked to hear reports regarding hundreds of millions of dollars in health care fraud. At the time, CNN reported that hundreds of people in America would face charges of Medicare fraud that totaled $900 million. One Florida owner of several clinics faced charges for $8 million in Medicare fraud, while a doctor in Texas also faced charges.

The defendants faced a long list of allegations, including the following:

  •          Conspiracy to commit health care fraud
  •          Violations of anti-kickback statutes
  •          Aggravated identity theft
  •          Money laundering

What consitutes white collar crime?

There are numerous types of white collar crime in Tennessee and around the country, and some people do not see it as serious as other types of crime. For victims of white collar crimes, however, the consequences can be major. This is why the federal government takes these cases very seriously. They spend a lot of resources investigating them, and there are serious penalties for those with convictions.

According to King University, a white collar crime is nonviolent and occurs in a commercial-type setting in the interest of financial gain. The perpetrators of this type of crime can be corporations or individuals, and the financial losses to the United States are around $300 billion every year. Most incidents require sophisticated planning and follow-through, and that makes them harder to investigate and prosecute. 

Some companies now hire rather than report hackers

Most times, when a hacker gets caught infiltrating a company’s database in Tennessee, the consequence is jailtime. However, for many hackers, the consequence is instead a full-time job working for the very company whose security they compromised. Some companies are no longer waiting for the security breach either. They are proactively hiring hackers to test their defense systems.

According to CNBC, freelance hackers can make half a million dollars per year to hack Tesla and the Department of Defense — legally. It may sound too good to be true but the figures came from bug bounty companies that provide a platform for hackers to help keep other hackers away from consumer data. These platforms allow hackers to use their skills for the greater good, while making a killing. Some even maintain employment elsewhere, while others have moved on to find great jobs in cybersecurity.

Predictive policing no longer just science fiction

In 2002, Minority Report made it to the big screen with Tom Cruise as the main star. In the movie, police officers were able to predict crime and arrest the person responsible before they committed the act. In 2015, Business Insider reported that some police departments in metropolitan cities, like Nashville Tennessee, now planned to follow a similar premise for real life crime fighting. They would do so by relying on data mining to prevent violent crime.

Predictive policing relies on algorithms to identify potential offenders. It may also help to locate when a crime may occur, who the likely victims are and where it may take place. In Kansas City, where predictive policing is widely used, there was a significant decline in the crime rate. However, it is not yet clear whether or not this futuristic type of policing is the main or only cause of this.

The potential causes of white collar crimes

Tennessee may not be the first state that comes to mind when people think of white collar crimes. Yet, it happens here nonetheless. Over the years, social scientists and journalists have studied white collar offenses all across the United States to better understand why it happens at all.  Their findings have been interesting.

According to Inc., there is a fine line between successful entrepreneurs and successful criminals.Both types of individuals tend to reject the status quo and have a more creative way of seeing the world and responding to its challenges. There is a constant desire to challenge what is considered normal, and in some cases, even what may be considered legal.

Examples of financial institution fraud

There are numerous ways one can commit financial institution fraud in Tennessee. Victims can be retail banks, credit unions, savings and loans associations, investment banks, insurance companies, brokerage firms and mortgage companies.

According to the Federal Deposit Insurance Corporation, bank fraud occurs when someone knowingly carries out a scheme to fraudulently obtain property or assets that belong to a financial institution or defraud them in any way. Convicted offenders can face serious penalties, such as up to 30 years in prison, up to $1 million in fines or both. This fraudulent activity can look like a variety of things. 

What different forms does health care fraud take?

If you find yourself accused of health care fraud, you might feel unsure about what that actually means. Health care fraud is an incredibly broad form of crime that can involve many different kinds of fraud.

Some people mistakenly believe that health care fraud only applies to people illegally obtaining benefits they shouldn't receive. However, individuals seeking personal health care benefits are only a tiny fraction of the health care fraud that happens in the United States.

Mortgage fraud may lead to severe penalties

Many Tennessee residents know that applying for a mortgage may be confusing and frustrating, especially with the lending changes that have occurred since the 2008 housing market crash. Making minor false statements on a loan application may seem innocuous, especially if listing factual data makes it difficult to qualify for a mortgage. However, the recent increase in mortgage fraud cases and convictions shows that there may be significant consequences to such actions.

Individuals who receive convictions for mortgage fraud may face fines and even imprisonment. In 2017, the United States Department of Justice reported the story of a Memphis real estate investor who pled guilty to mortgage fraud. This person made false statements on loan documents to secure funding from various lenders and dispensed some of the loan proceeds to borrowers who were purchasing his properties. The FBI and other federal agencies participated in the investigation. The maximum possible penalties for the crimes included a fine of $1 million and up to 30 years in prison.

Manufacturing meth makes big problems

Would you recognize a meth lab in your own neighborhood? A Memphis neighborhood had suspected their neighbors of running a meth lab but weren’t certain until it exploded during Valentine’s Day week. The occupants of the house were fortunate to only sustain minor injuries since meth lab explosions can be fatal.

Meth use in Tennessee has skyrocketed in recent years. This has occurred while law enforcement has faced budget cuts that make it more difficult to crack down on the manufacturing and distribution of the drug. That makes it more important for citizens to be able to identify meth labs. Common signs of a meth lab include:

Examples of Medicare fraud

Medicare fraud is quite a common occurrence in Tennessee and throughout the country. This can put patients' health at risk, and it also costs taxpayers a lot of money. Many different parties can commit this type of fraud and, if caught, the penalties can be severe.

According to California Health Advocates, Medicare fraud can happen in a number of ways. The parties who commit fraud include healthcare providers, insurance brokers, equipment suppliers, pharmacists, companies and beneficiaries. Some examples of how fraud occurs include:

  • Provider bills for unnecessary services or services that did not occur
  • Brokers make unsolicited home visits or phone calls
  • Suppliers bill for different equipment than what the beneficiary got
  • Pharmacists fill a script with an expired drug
  • Beneficiaries let someone else use their Medicare number
  • Companies offer bribes to providers to prescribe a particular medication 
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Murfreesboro Office
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Murfreesboro, TN 37130

Toll Free: 800-673-1947
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