Medicare Fraud Strike Force Probe Snares 91 Individuals for Nearly $430 Million in False Billing

The response to the recent New York Times article on Medicare billing fraud is continuing, this time with some serious punch, as Medicare Fraud Strike Force operations in seven cities have led to charges against dozens individuals for their alleged participation in Medicare fraud schemes.

Overall there were charges filed against 91 individuals including doctors, nurses and other licensed professionals for the alleged participation in Medicare fraud schemes involving approximately $429.2 million in false billing.  The figure is made up of $230 million in home health care fraud, over $100 million in mental health care fraud and over $49 million in ambulance transportation fraud.  There were approximate $60 million in other frauds.

“Today’s arrests put criminals on notice that we are cracking down hard on people who want to steal from Medicare,” said HHS Secretary Sebelius. “The health care law gives us new tools to better fight fraud and make Medicare stronger. In addition to the arrests made today, HHS used new authority from the health care law to stop future payments to many of the health care providers suspected of fraud, saving Medicare resources and taxpayer dollars from being lost to fraud in the first place.”

The joint Department of Justice and HHS Medicare Fraud Strike Force is a multi-agency team of federal, state and local investigators and prosecutors designed to combat Medicare fraud through the use of Medicare data analysis techniques. More than 500 law enforcement agents from the FBI, HHS-OIG, multiple Medicaid Fraud Control Units, and other state and local law enforcement agencies participated in the arrests.

Other details include:

  • 33 defendants in Miami are charged for their alleged participation in various fraud schemes involving a total of $204.5 million in false billings for home health care, mental health services, occupational and physical therapy, and DME.
  • 16 individuals in Los Angeles,  including three doctors and one licensed physical therapist, are charged with participating in various fraud schemes involving a total of $53.8 million in false billings.
  • 14 individuals in Dallas,  including two doctors and two registered nurses,  are charged for their alleged participation in various fraud schemes involving a total of $103.3 million in false billings.
  • 7 individuals are charged in Houston for their participation in a fraud scheme at a hospital which led to $158 million in fraudulent billing for community mental health center services.

Obviously these investigations weren’t started based upon an article in last week’s New York Times, so the investigation has been going on for quite some time.  However, I wouldn’t be surprised if the arrests were moved up as a response to the article.

It’s great to see action being taken against those seeking to defraud the system and it should serve as a warning not only to those involved in Medicare fraud but to those considering short cuts in attesting for meaningful use.

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This entry was posted in Centers for Medicare & Medicaid Services (CMS), Electronic Health Records, Latino HIT, LISTA Global Health IT, meaningful use, National Latino Alliance on Health Information Technology, Patient Care, policy and tagged , , , , , , . Bookmark the permalink.

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