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DOJ indicts 53 accused of Medicare fraud

By Bernard Hibbitts (editor) and University of Pittsburgh School of Law students.

[JURIST] The US Department of Justice (DOJ) announced indictments Wednesday against 53 health care providers and beneficiaries accused of submitting $50 million in fraudulent Medicare claims. The indictments, returned by a grand jury in Detroit, led to the arrest of suspects in Detroit, Miami, and Denver whom the government alleges billed the federal health care program for treatments that were "medically unnecessary and oftentimes, never provided." US Department of Health and Human Services (HHS) Secretary Kathleen Sebelius said that the efforts of the Health Care Fraud Prevention and Enforcement Action Team (HEAT) to reduce Medicare fraud were necessary to the financial health of the program. Our Medicare program is working closely in partnership with our own and other law enforcement operations to prevent fraud from happening in the first place. Every dollar we can save by stopping fraud can be used to strengthen the long-term fiscal health of Medicare, bring down costs and deliver better service to Medicare beneficiaries.Attorney General Eric Holder said that fraudulent Medicare schemes "not only undermine a program upon which 45 million aged and disabled Americans depend, but ... also contribute directly to rising health care costs."The formation of HEAT, an interagency effort between the HHS, which oversees Medicare, and the DOJ, was announced in May, as an expansion of the Medicare Fraud Strike Force program aimed at curbing durable medical equipment (DME) fraud in Los Angeles and South Florida. Fraud reduction is part of a larger effort to control the rising cost of the Medicare and Medicaid programs. In October, the US Centers for Medicare and Medicaid Services (CMS) implemented regulations denying hospitals payment for treating conditions caused by some common medical errors. The new regulations were authorized by the Deficit Reduction Act of 2005, which directed the HHS to identify reasonably preventable conditions that result in high-cost or high-volume treatment and additional government payments.

Full post as published by JURIST - The Paper Chase on June 25, 2009 (boomark / email).