Detecting and Investigating Healthcare Fraud: A Real-World Case Study with Walter Smith Randolph

In this training session, Walter Smith Randolph will walk attendees through a real Medicare fraud investigation that exposed a multimillion-dollar scheme involving fraudulent billing for medical supplies that patients never ordered or received.

Using a case connected to a Brooklyn-based business and a larger fraud ring, Randolph explains how complaints from Medicare recipients led to the discovery of suspicious billing patterns, the validation of victim reports and the development of evidence that supported federal charges against 11 individuals.

Participants will learn how to recognize red flags in healthcare billing, corroborate victim statements with documentation, follow financial and records trails and organize findings into a story that can withstand legal scrutiny. This session provides practical insight into how large-scale healthcare fraud is detected, investigated and built into a prosecutable case.