NDBA - North Dakota Bankers Association
04/01/2026 | Press release | Distributed by Public on 04/01/2026 08:09
FinCEN Issues Advisory for Financial Institutions on Medicare, Medicaid Fraud
The Financial Crimes Enforcement Network has issued a financial institution advisory on red flags related to alleged fraudulent healthcare schemes targeting Medicare, Medicaid, and other Federal and state healthcare benefit programs.
The red flags are intended to help financial institutions detect and report suspicious activity associated with potential fraud in healthcare benefit programs. FinCEN is encouraging financial institutions to review whether their customers receive payments from Medicare administrative contractors or state-level agencies for healthcare benefit reimbursements. It also encourages institutions to use a risk-based approach to assess whether those payments are consistent with their customers' profiles. In addition, financial institutions are "strongly encouraged" to contact law enforcement about fraud schemes, the agency said.
"As no single red flag is determinative of illicit or suspicious activity, financial institutions should consider the surrounding facts and circumstances, such as a customer's historical financial activity, whether the transactions are in line with prevailing business practices, and whether the customer exhibits multiple red flags, before determining if a behavior or transaction is suspicious or otherwise indicative of a connection to healthcare fraud," the advisory states.
To read more, visit: https://www.fincen.gov/system/files/2026-03/FinCEN-Advisory-Health-Care-Fraud.pdf
The red flags are intended to help financial institutions detect and report suspicious activity associated with potential fraud in healthcare benefit programs. FinCEN is encouraging financial institutions to review whether their customers receive payments from Medicare administrative contractors or state-level agencies for healthcare benefit reimbursements. It also encourages institutions to use a risk-based approach to assess whether those payments are consistent with their customers' profiles. In addition, financial institutions are "strongly encouraged" to contact law enforcement about fraud schemes, the agency said.
"As no single red flag is determinative of illicit or suspicious activity, financial institutions should consider the surrounding facts and circumstances, such as a customer's historical financial activity, whether the transactions are in line with prevailing business practices, and whether the customer exhibits multiple red flags, before determining if a behavior or transaction is suspicious or otherwise indicative of a connection to healthcare fraud," the advisory states.
To read more, visit: https://www.fincen.gov/system/files/2026-03/FinCEN-Advisory-Health-Care-Fraud.pdf
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