This week Department of Health and Human Services (HHS), the Department of Justice (DOJ), and local law enforcement in 17 different cities across the country arrested 243 individuals for an alleged $US712 million in fraudelent Medicare charges.
“These are extraordinary figures,” said Attorney General Loretta Lynch at a press confrence. “They billed for equipment that wasn’t provided, for care that wasn’t needed, and for services that weren’t rendered.”
Court documents alledge that Medicare claims were submitted for unnecessary procedures that often were never even provided, and that in some cases, Medicare beneficiaries were paid cash kick-backs for providing their information to healthcare providers who submitted fraudelent claims.
“The people charged in this case targeted the system each of us depends on in our most vulnerable moments,” said FBI Director James B. Comey in a press release. “Health care fraud is a crime that hurts all of us and each dollar taken from programs that help the sick and the suffering is one dollar too many.”
The press release explained how the FBI was able to collect and analyse vast sums of data on medicare, and to deploy rapid response teams where the data showed fraud. “In these cases, we followed the money and found criminals who were attracted to doctors offices, clinics, hospitals, and nursing homes in search of what they viewed as an ATM,” said Comey.
The FBI press release detailed the cases in three of the worst offending cities:
- In Miami, 73 were charged in schemes involving about $US263 million in false billings for pharmacy, home health care, and mental health services.
- In Houston and McAllen, 22 were charged in cases involving more than $US38 million. In one case, the defendant coached beneficiaries on what to tell doctors to make them appear eligible for Medicare services and then received payment for those who qualified. The defendant was paid more than $US4 million in fraudulent claims.
- In New Orleans, 11 people were charged in connection with home health care and psychotherapy schemes. In one case, four defendants from two companies sent talking glucose monitors across the country to Medicare beneficiaries regardless of whether they were needed or requested. The companies billed Medicare $US38 million and were paid $US22 million.
The DOJ alone has recovered more than $US15 Billion in health care fraud related cases in the last five years. Strike Force cases reportedly result in an average sentence of 4 years, with some cases resulting in 50 year bids. To date, the defendants include some 200 doctors and 400 medical professionals have been charged so far by the Medicare Fraud Strike Force.
“This record-setting takedown sends a message to would-be perpetrators that health care fraud is a risky way to line your pockets,” US Department of Health Inspector General Daniel Levinson stated. “Our agents and our law enforcement partners stand ready to protect these vital programs and ensure that those who would steal from federal health care programs ultimately pay for their crimes.”
The Medicare Fraud Strike Force have charged over 2,300 defendants for more than $US7 billion in suspected fraudelent charges since their establishment in 2007.
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