This is a huge problem in south Florida.  There are a few refugees that open fake clinics in local strip malls.  There are also some doctors that send vans into specific neighborhoods.  They ask the kids if they have Medicaid and they will given the kid $5 if they go with them in the van and they bring their Medicaid card.  The kid does, gets the $5 and the doctors bill out millions to Medicaid and Medicare. 

One refugee doctor was billing for silicone implants, sadly, the silicone was the kind used for window sealant you can get from Lowes, Home Depot or Walmart.  I can go to one of my local stores and in the store, near the entrance, is a folding table, and someone representing themselves as a nurse.  They only take Medicare patients, have the patient fill out forms and they send a claim to Medicare for what they supposedly did to the patient while at the table.  
 
So, not only does the insurance companies have to protect themselves against fraud or abuse, but the good, innocent doctor is caught up in it as well.  On a side note, a doctor friend of mine had her own practice.  She had crappy contracts with the insurance companies.  I advised her to renegotiate.  She refused.  She found a part time job at a local clinic.  None of the doctors at the clinic were enrolled with Medicare.  The clinic biller sent all claims to Medicare, listing my doctor friend as the provider even though another doctor treated the patient.  The clinic biller did this using my doctor friend's Medicare numbers.  Medicare put a hold on every clinic claim as well as every claim from my friend.  Every commercial insurance company also put a hold on her claims.  Medicare did a fraud investigation.  They told my friend that she was responsible for claims sent in her name.  The State put her license on probation. Medicare sanctioned her.  The commercial insurance companies refused to pay any claim.  MY friend closed her practice.  Near the end, she was living on credit cards.  She has since turned in her medical license. Paid hefty fines which are under appeal, she left the state and was devistated.  Her whole life was ruined because a biller allowed claims to go out which should not have gone out. The biller felt it was more important to get the claims paid.  The biller has yet to find another job.  The part time clinic was also closed.  I dont know what happened to those doctors.  They too may have been sanctioned and fined. 

I cant express it enough that we must always ensure that we comply with laws, policies and rules, in addition to ensuring that a claim we send is 100% true accurate and correct.  If we do what is correct, our claims should be paid in a reasonable timeframe and we have no fear of audits or insurance company requests.