Qui Tam

Medicare Fraud Strike Force charges 111 in $225 Million Fraud Scheme

By LaBovick Law

Recently, the Health and Human Services Department, Department of Justice, and FBI issued a joint announcement that they were charging 111 defendants with Medicare fraud in nine cities, and expanding their investigative operations, called the Medicare Fraud Strike Force, to two more cities. The 111 charges is the largest federal health care fraud take-down in history.

Who's Defrauding Medicare?

The 111 individuals charged consisted mostly of doctors, nurses, and health care company owners / executives. The fraud consisted of over $225 million in false billing.

Attorney General Eric Holder stated that the arrests prove that the Department of Justice is 'waging an aggressive fight against health care fraud' and securing taxpayer dollars. In 2010 alone, Holder went on to say, the Medicare Fraud Strike Force recovered more than $4 billion in fraudulent Medicare claims. The Strike Force focuses primarily on identifying and shutting down large-scale fraud schemes.

Examples of Fraud

The arrests on February 17 included some of the following examples:

Miami 32 defendants, including 10 health care professionals, participated in frauds that led to $55 million in false billings. The false billings were mostly for home health care, medical equipment, and prescription drugs.
 

• Detroit:21 defendants, including 9 health care professionals, defrauded Medicare for $23 million. These cases included home health care, psychotherapy, physical therapy, and podiatry.
• Brooklyn: A mere 10 people, including 4 health care professionals, managed to run schemes that totaled $90 million. These schemes focused on physical therapy, proctology, and nerve conduction testing.
• Los Angeles: 5 individuals defrauded Medicare for $28 million, mostly with false claims for medical equipment and home health care.

The strike force intends to expand its operations into Dallas and Chicago – the next two cities that have been identified as fraud hot spots.

Medical Identity Theft

The Office of the Inspector General (OIG) calls attention to a new sort of identity theft – medical identity theft. This identity theft relies upon a person's name, Social Security number, or Medicare number to make false prescription drug claims and other false Medicare claims. Like other types of identity theft, medical identity theft can threaten the victim's credit and finances, while simultaneously defrauding taxpayers.

As basic precautions against healthcare fraud, OIG suggests the following measures:

• Protect your information by not giving out your Medicare number to people who offer free medical equipment or services, or who offer a free gift in exchange for a Medicare number.
• Check your Medicare Summary Notices to see if you were billed twice for anything or if you were charged for any services or equipment that you didn't receive.
•  If you do suspect someone is using your Medicare or Social Security number to commit fraud, contact the Department of Health and Human Services

Considering the ongoing, heated debates over health care in America, watching out for medical identity theft is one step Medicare recipients can take to ensure all taxpayers are protected from healthcare fraud.
 

Full post as published by Whistleblower Law Blog on March 08, 2011 (boomark / email).