Medicare Fraud Strike Force: your tax dollars in action

by pharmacy on May 30, 2012

On May 2, over 500 law enforcement agents from the FBI, HHS-Office of Inspector General (HHS-OIG), multiple Medicaid Fraud Control Units, and other law enforcement agencies came down like a ton of bricks on medical professionals in seven cities across the nation. The massive sting nailed 107 doctors, nurses, social workers, and other medical professionals on charges of Medicare fraud that reputedly bilked the government out of $452 million through fraudulent billing practices.

In addition, HHS suspended payments for 52 providers pending fraud investigations. The Affordable Health Care Act increased HHS’s power to suspend payments during investigations. Health care fraud, violations of the anti-kickback statutes, and money laundering cost taxpayers hundreds of millions of dollars each year, and the Medicare Fraud Strike Force is focused on ending that.

The OIG special agents, forensic examiners, and analysts who make up the strike force identified doctors, nurses, other medical professionals, and healthcare business owners who participated in schemes to submit fraudulent bills for services that were either unnecessary or never provided to patients. Medicare patients and other involved parties were often paid kickbacks for allowing their beneficiary information to be used in the billing fraud.

Task Force member FBI Deputy Director Joyce said, “Health care fraud is not a victimless crime. Every person who pays for health care benefits, every business that pays higher insurance costs to cover their employees, every taxpayer who funds Medicare—all are victims.”

This action is the fourth major Medicare fraud takedown in two years. Since the strike force was formed in 2007, more than 1,330 people have been arrested and charged with fraudulently billing Medicare for over $4 billion, collectively.

The specifics:

In Miami, 59 people were charged. Ten of those were associated with Health Care Solutions Network, accused of altering notes and medical documents to justify community mental health center (CMHC) services for Medicare patients who did not need the billed services in order to scam $63 million.

Twenty-two people were arrested in Detroit, including four social workers, for fraud involving home health, psychotherapy, and infusion therapy, to the tune of $58 million.

In Los Angeles, the smackdown came for eight medical professionals involved in schemes to rob $14 million in Medicare benefits.

Baton Rouge yielded only seven perpetrators, but they were busy little bees, defrauding Medicare out of a whopping $225 million in false CMHC claims.

Nine people were charged in Houston for falsely billing $16.4 million in home health care and ambulance services.

One person was nailed in Chicago for $1 million in fraudulent psychotherapy service billings.

One pharmacist in Tampa was charged with illegal diversion of controlled substances.

Is this the fix?

With the staggering cost of Medicare skyrocketing as 80 million baby boomers age, it’s obvious something has to be done, and this surely sounds like a good start. But it is cost effective? HHS says it is. In fact, they say that for every dollar spent to fight Medicare fraud, taxpayers see a return of $6.80. Is it possible that part of the skyrocketing cost of health care can be controlled by fraud prevention? What do you think? Is fraud prevention a game-changing flood of reform…or just a drop in the bucket?

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