Feds announce nationwide health care fraud sweeps

June 18, 2015 byRicardo Alonso-Zaldivar
Feds announce nationwide health care fraud sweeps
Attorney General Loretta E. Lynch, center, with Health and Human Service (HHS) Secretary Sylvia Burwell, left, and FBI Director James Comey, speaks during a news conference at the Justice Department in Washington, Thursday, June 18, 2015. The government says 243 people have been charged in health care fraud sweeps around the country. That includes doctors, nurses and pharmacy owners accused of bilking Medicare and Medicaid. Combining all the cases, fraudulent billings allegedly totaled some $712 million. Lynch says the defendants billed for equipment that wasn't provided, care that wasn't needed, and services that weren't rendered. While the individual cases may be unrelated, law enforcement agencies often coordinate the announcement of health fraud charges and arrests to send a message to fraudsters and the general public alike. Health care fraud costs tens of billions of dollars annually. (AP Photo/Pablo Martinez Monsivais)

Health care fraud sweeps across the country have led to charges against 243 people, including doctors, nurses and pharmacy owners accused of bilking Medicare and Medicaid, the government announced Thursday.

The dragnet spread from Miami to Los Angeles, and Dallas to Brooklyn, N.Y. Arrests were made earlier this week. Combining all the cases, allegedly fraudulent billings totaled some $712 million.

While the individual cases were unrelated, often coordinate the announcement of health charges and arrests to send a message to fraudsters and the general public alike. Health care fraud costs tens of billions of dollars annually, another drain on Medicare, whose long-term financial outlook is already shaky.

Attorney General Loretta Lynch said the defendants billed for equipment that wasn't provided, care that wasn't needed, and services that weren't rendered. In Detroit, the owners of a hospice service were charged with paying kickbacks for referrals to a couple of doctors who also allegedly wrote bogus prescriptions, defrauding Medicare's prescription program.

The crackdown focused particularly on prescription fraud. More than 40 of those charged were involved in scams that targeted Medicare's drug benefit, projected to be the fastest-growing part of the program.

"For us, the greatest concern looking forward is the ," said Gary Cantrell, top investigator for the Health and Human Services inspector general's office. He said schemes typically involve billing for drugs that are never dispensed or billing for narcotics and painkillers that are diverted to street sales.

The scams shut down by federal and state agents read like a manual for :

— In New Orleans, four people were charged in a marketing scheme that involved sending blood sugar monitors to Medicare recipients, whether or not they needed them, or had even asked for them. Their companies billed Medicare $38 million for the devices, and the program paid $22 million.

— A doctor in Los Angeles was charged with making bogus referrals for unneeded medical equipment, including more than 1,000 power wheelchairs.

— Miami remained the capital of fraud, accounting for 73 of the defendants. In one case, administrators of a mental health center allegedly paid kickbacks to middlemen who recruited patients for a fraudulent billing operation. The center billed Medicare $64 million over six years, and the program paid about half that.

Part of Medicare's vulnerability to fraud is that the program is legally required to pay claims promptly. That sets up a frustrating cycle that investigators call "pay and chase." But Medicare has become a harder target over the last decade, with more extensive monitoring of claims before they are paid, and stiffer penalties for scam artists.

Participating in the crackdown were U.S. attorneys' offices around the country, the FBI, the HHS inspector general's office, and state Medicaid fraud units.

.

Explore further: US charges 91 in wave of health fraud cases

Related Stories

US charges 91 in wave of health fraud cases

September 8, 2011
US authorities have charged 91 people over some $295 million in alleged fraud schemes related to Medicare, the government-run health program for seniors, the Justice Department said.

Feds charge 91 people in $429M Medicare fraud

October 4, 2012
(AP)—A federal strike force has charged 91 people, including doctors and nurses, in seven cities with Medicare fraud schemes involving $429 million in false billings.

New Medicare fraud detection system saves $115 mil

December 14, 2012
A highly touted new system designed to stop fraudulent Medicare payments before they are paid has saved about $115 million and spurred more than 500 investigations since it was launched in 2011.

Vast trove of Medicare data details how billions are spent

June 1, 2015
Joint replacement was the most common hospital procedure that Medicare paid for in 2013, accounting for nearly 450,000 inpatient admissions and $6.6 billion in payments.

Recommended for you

A topical gel that can prevent nerve damage due to spraying crops with pesticides

October 22, 2018
A team of researchers affiliated with several institutions in India has developed a topical get that can be used by farmers to prevent nerve damage due to chemical crop spraying. In their paper published in the journal Science ...

Community health workers can reduce hospitalizations by 65 percent and double patient satisfaction with primary care

October 22, 2018
Community health workers—trusted laypeople from local communities who help high-risk patients to address social issues like food and housing insecurity—can help reduce hospital stays by 65 percent and double the rate ...

Moderate exercise before conception resulted in lower body weight, increased insulin sensitivity of offspring

October 22, 2018
Men who want to have children in the near future should consider hitting the gym.

Modern conflict: Screen time vs. nature

October 22, 2018
Even rural kids today spend more time in front of screens and less time outdoors, according to a new study of middle-school students in South Carolina.

Juul e-cigarettes pose addiction risk for young users, study finds

October 19, 2018
Teens and young adults who use Juul brand e-cigarettes are failing to recognize the product's addictive potential, despite using it more often than their peers who smoke conventional cigarettes, according to a new study by ...

Self-lubricating latex could boost condom use: study

October 17, 2018
A perpetually unctuous, self-lubricating latex developed by a team of scientists in Boston could boost the use of condoms, they reported Wednesday in the journal Royal Society Open Science.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.