Medicare Fraud Tops $900 Million in Massive Crackdown

By - July 15, 2016
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The most recent chapter in the government’s National Health Care Fraud Takedown has netted 301 defendants, including 61 doctors, nurses and other medical professionals. Taken together, these medical professionals and health care companies schemed to submit a total of $900 million in phony billing to the Medicare program.

Since 2010, the federal government has arrested and charged 1200 people who were allegedly defrauding both the Medicare and Medicaid programs of $3.5 billion.

These most recent charges were revealed after federal investigators found many types of fraud schemes that involved many medical services, including home health care, physical therapy, occupational therapy, medical equipment sales and prescription drugs.

At least 60 of those who were arrested were charged with fraudulent claims for Medicare Part D.

According to Attorney General Loretta Lynch, health care fraud is a serious crime, and those who do it are using public funds for their private benefit. These crimes target real people, and many of them need good medical care, but these wrongdoers do not provide it.

Lynch also said that these fraudulent actions are a major betrayal of the public trust that goes after the most vulnerable in our society. They are taking away money from the care of children, the elderly and disabled.

Assistant Attorney General Leslie Caldwell added that the federal government has perfected advanced ways to find Medicare and Medicaid fraud.

HHS Secretary Sylvia Mathews Burwell stated that at least $350 million was reserved for part of the Affordable Care Act to prevent fraud. She noteed that millions of seniors need Medicare for their health coverage, and the government’s actions shows that the Obama Administration is committed to punishing people who defraud the system.

The Southern District of Florida was revealed to have a great deal of illegal activity. More than 100 people were charged with offenses that involved defrauding the Medicare and Medicaid programs, totalling $200 million in fake billings for home health care, pharmacy fraud and mental health services.

In Texas, 24 people were charged in fraud cases with over $146 million incorrectly billed to the programs. One of the suspects was a doctor who had the greatest number of referrals for home health care services in the entire state. In central CA, 22 people were charged with conspiracies to rip off the Medicare program of $162 million.

One of the cases involved a pharmacist in Beverly Hills, three medical marketing workers and a doctor all of whom were indicted on health care fraud charges.

They were accused of offering bribes to doctors to prescribe a variety of pain creams and medical devices that were not really needed. The prescriptions were then filled by the pharmacist in Beverly Hills, or at companies where the marketers had a financial interest.

The companies then billed Medicare for unneeded medications at huge markups. For instance, one indictment said that a pain cream can be made for $20, but insurers could be billed $3000.

In total, this particular set of defendants billed $27 million to Medicare and Medicaid fraudulently.

About Medicare Fraud

Most health care providers who work with government health care programs are honest. However, there are always a few who are not. Medicare, Medicaid and healthcare fraud happens when a doctor bills the program for services that he or she did not receive. As the above story shows, healthcare programs run by the government lose billions to fraud each year.

Government healthcare programs are putting more of a priority on trying to find and stop waste, fraud and abuse in the system.

There are five laws that are related to healthcare fraud and abuse in the US at the federal level. The most important laws are:

  • False Claims Act
  • Exclusion Mandate
  • Civil Monetary Penalty Law
  • Anti Kickback Statute
  • Physician Self Referral Act

Examples of healthcare fraud include these:

  • A doctor bills Medicare for services that he never performed.
  • A medical device supplier bills the Medicare program for equipment that was never delivered to a patient.
  • Someone uses the Medicare services of another person to receive their health care supplies or care.
  • A company offers drug plans offered by Medicare but has not yet been approved by the program.

Any healthcare professional who commits this sort of fraud faces serious punishment. First of all, you will have to repay any government health care overpayments that you received. You also will be severely fined. In some cases, you may have to do prison time. Many healthcare professionals who commit this type of fraud receive five years in prison.

Also, you may be fined as much as $250,000 for every health care fraud offense. An organization may be fined up to $500,000 per offense. Thus, it is very important for all Medicare providers to follow the letter of the law.