Medical Fraud

At Mitha Intel, we stand as a relentless force against the shadows of medical fraud, wielding open-source intelligence (OSINT) and confidential consulting to expose the schemes that drain billions from healthcare systems, exploit vulnerable patients, and inflate costs for taxpayers and insurers alike.

In an era where healthcare expenditures soar and enforcement struggles to keep pace—exemplified by the record-breaking 2025 National Health Care Fraud Takedown, which charged 324 defendants (including 96 licensed medical professionals) for schemes involving over $14.6 billion in intended losses—Mitha Intel delivers unflinching truths that empower providers, payers, regulators, corporations, and individuals to combat systemic abuse. We do not merely report on fraud—we dismantle it through rigorous forensic analysis, network mapping, and strategic countermeasures that pierce obfuscation and drive accountability.

Defining Medical Fraud: A Systemic Epidemic

Medical fraud involves the deliberate deception or misrepresentation in healthcare billing, services, or products for unauthorized financial gain, manifesting in forms from blatant false claims and kickbacks to sophisticated transnational operations and technology-enabled schemes. It thrives in opaque environments where providers, suppliers, and networks exploit federal programs like Medicare and Medicaid, diverting resources meant for patient care into private pockets. At Mitha Intel, we view medical fraud not as isolated acts but as interconnected criminal enterprises that harm patients, erode trust in healthcare, and burden economies—often at the expense of the elderly, disabled, and underserved. Our investigations reveal how these networks span domestic providers and foreign actors, infiltrating everything from routine billing to high-value durable medical equipment and prescription drugs.

Through our OSINT services—some freely available to raise public awareness and others premium-access for detailed insights—we provide real-time exposures and analyses. For confidential clients, we offer bespoke consulting that includes discreet pattern surveillance, predictive risk modeling, and actionable strategies to prevent losses, ensure compliance, or support prosecution.

Our Track Record in Exposing Upcoding, Kickbacks, and Transnational Schemes

Mitha Intel has a proven history of unmasking upcoding and kickback operations that involve licensed professionals and corporate entities. Upcoding—billing for more expensive or complex services than provided to inflate reimbursements—often intersects with unnecessary procedures when providers exploit coding ambiguities or pressure from incentives. We employ advanced OSINT to trace anomalous billing patterns, cross-reference claims with medical records, and uncover hidden financial ties that evade standard audits.

Kickbacks represent the insidious underbelly of influence peddling—illegal payments or incentives to steer patients, prescriptions, or referrals toward specific drugs, devices, or services. Our investigations have spotlighted cases where providers receive undisclosed perks, funnel contracts to cronies, or manipulate procurement. By leveraging public records, whistleblower intelligence, and network analysis, we construct irrefutable dossiers that inform legal actions, regulatory reforms, and client protections.

Tackling Pharmaceutical Diversion, False Claims, and Emerging Threats

A cornerstone of our medical fraud expertise lies in dissecting schemes riddled with diversion, false billing, and abuse. In the 2025 takedown—hailed as the largest in DOJ history—Operation Gold Rush alone targeted a transnational network submitting $10.6 billion in fraudulent Medicare claims for urinary catheters and durable medical equipment using stolen identities of over one million Americans, with proceeds laundered overseas. Other cases involved $1.1 billion in unnecessary amniotic wound grafts on elderly patients, over $1.17 billion in telemedicine/genetic testing fraud, and diversion of more than 15 million opioid pills through pill mills and forged prescriptions.

We also target emerging tactics like AI-generated fake consents for deceptive marketing or straw-owner companies masking foreign operations. By parsing claims data, tracking amendments, and mapping lobbyist or criminal influences, Mitha Intel uncovers how these mechanisms prioritize profit over patient welfare. Our findings equip clients with evidence to advocate for reforms, launch internal audits, or shield against financial and reputational risks.

Uncovering Institutional and Transnational Exploitation

No entity escapes scrutiny at Mitha Intel, including large-scale institutional players and international networks. We delve into violations where providers bill for services never rendered, exploit relaxed pandemic-era rules for overbilling, or engage in opioid trafficking that endangers communities. Through meticulous review of declassified enforcement actions, whistleblower accounts, and cross-verified OSINT, we expose how these operations harm vulnerable populations—elderly Medicare beneficiaries, Native American communities in addiction programs, and patients reliant on hospice or wound care—while fostering unaccountable profit.

For confidential clients facing risks from medical fraud exposure—such as targeted audits, liability from affiliated networks, or fallout from schemes—we provide strategic countermeasures grounded in compliance precedents and evasion intelligence.

Why Choose Mitha Intel for Medical Fraud Insights?

What sets us apart is our non-status quo approach: we reject bureaucratic inertia in favor of constant vigilance and multifaceted analysis. Founded by Mitha, whose background in high-stakes political intelligence intersects with a commitment to forensic rigor, we bypass red tape to deliver bold, aggressive insights that conventional firms avoid. Our ethical framework ensures relentless pursuit of open sources while upholding strict confidentiality in client matters.

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For tailored contracting or custom confidential engagements, beyond our à la carte consulting, contact us with a brief inquiry outlining your intent, industry, and primary needs.