Nation-wide Crackdown on Medicare Fraud Lands 89 People with Fraud Charges

Attorney General Eric Holder and Department of Health and Human Services (HHS) secretary Kathleen Sebelius announced today that a nationwide bust in 8 cities resulted in charges against 89 people – doctors, nurses, and other licensed medical professionals – for participating in or organizing Medicare fraud schemes, which amounted to $223 million in false billing.

The coordinated bust was the sixth national Medicare fraud takedown in strike force history. So far, almost 600 people have been charged in connection to Medicare fraud schemes involving close to $2 billion in fraudulent billings.

The Medicare Fraud Strike Force operations are part of the Health Care Fraud Prevention and Enforcement Action Team (HEAT), a joint initiative announced in May 2009 between the Department of Justice and HHS to focus their efforts to prevent and deter fraud and enforce current anti-fraud laws around the country.

Holder and Sebelius allege that Medicare fraud costs the federal program between $60 and $90 billion each year.

The national crackdowns are part of implementation of the Affordable Care Act next year. By cracking down hard on Medicare fraud, Holder and Sebelius believe they can help fund the Affordable Care Act.

“[Because of] healthcare reform, President Obama will try to find any Medicare fraud or abuse they can to reclaim money,”  said John Durso, JD, partner at Ungaretti and Harris, at Life Services Network’s annual meeting and expo in May. “[The administration] is focusing on that in our Medicare programs, in nursing homes and hospitals, to try to fund the expansion of healthcare reform to those who are currently uninsured.”

Under the Obama administration’s health care reform, more than 21 million people will be eligible for Medicaid-funded insurance coverage, provided all states participate in Medicaid/Medicare expansion.

The recent bust spanned cities from Miami, Los Angeles, Houston, Brooklyn, Detroit, Chicago, Tampa, Fla., and Baton Rouge, La.

Miami, long a hot-spot for Medicare fraud due largely to the burgeoning retirement communities there, was the center of Tuesday’s bust. Twenty-five people were arrested for their roles in various Medicare fraud schemes. According to authorities, at least five of the defendants in one scheme bribed Medicare patients for their ID numbers, then billing Medicare for $51 million in home health services that were never given and were never medically necessary.

In Detroit, almost 20 people, including two doctors, a physician’s assistant, and two therapists, were charged for various Medicare fraud scams. Three of those defendants allegedly posed as licensed physicians and wrote fake prescriptions for drugs and psychotherapy services, totaling $12 million.

Thirteen people were charged in Los Angeles for various Medicare fraud scams totaling $23 million. One case involved three people who hired workers to recruit Medicare patients specifically. Once the defendants received the patients’ Medicare ID numbers, they obtained prescriptions for power wheelchairs, which they sold for kickbacks.

“The Affordable Care Act has given us additional tools to preserve Medicare and protect the tens of millions of Americans who rely on it each day,” said Secretary Sebelius. “By expanding our authority to suspend Medicare payments and reimbursements when fraud is suspected, the law allows us to better preserve the system and save taxpayer dollars. Today we’re sending a strong, clear message to anyone seeking to defraud Medicare: you will get caught and you will pay the price. We will protect a sacred trust and an earned guarantee.”

The Strom Law Firm Can Help Protest Whistleblowers in Medicare Fraud Cases

If you have first-hand knowledge of government fraud occurring at your place of employment or your doctor’s office, including Medicare fraud, the attorneys at the Strom Law Firm can help protect your rights. In order to help the government provide the best possible services, Medicaid and Medicare fraud must be reported as soon as possible. The attorneys at the Strom Law Firm understand the complexity of qui tam and whistleblower suits, and we offer free, confidential consultations to discuss the facts of your case. Contact us today.803.252.4800