Big Medicare fraud bust hits home

May 9, 2012

Remind your staff to be diligent in coding, especially when billing for Medicare. More than 100 recent fraud arrests show that the government is getting serious about recovering lost money, as providers in six states learned the hard way.

You would be well-advised to keep a close eye on your staff members and remind them to be diligent in coding and billing, especially when it comes to Medicare, in light of a recent string of arrests. More than 100 people have been accused of making roughly $450 million in false billing claims against the federal healthcare program.

U.S. Department of Health and Human Services (HHS) Secretary Kathleen Sebelius and Attorney General Eric Holder say a nationwide effort involving more than 500 law enforcement agents participating in the Medicare Fraud Strike Force resulted in criminal charges against 107 healthcare providers and administrative action or suspensions against another 52. The $452 million in alleged false billing is the most pursued in a single takedown in the strike force’s 5-year history.

Since 2007, the strike force has charged more than 1,330 defendants who have allegedly falsely billed Medicare for more than $4 billion. HHS says the Patient Protection and Affordable Care Act has significantly increased the department’s ability to suspend payments until an investigation is complete.

The latest round of charges was made against:

59 defendants-including three nurses and two therapists-in Miami, Florida, for a total of $137 million in alleged false billing for home healthcare, mental health services, occupational and physical therapy, durable medical equipment (DME), and anti-HIV drug infusion;

seven individuals in Baton Rouge, Louisiana, for alleged participation in a $225 million fraud scheme for community mental healthcare services;

nine defendants in Houston, Texas-including one doctor and one nurse-for allegedly defrauding Medicare of $16.4 million in false billings for home healthcare and ambulance services;

eight individuals-including two doctors-in Los Angeles, California, for allegedly making $14 million in false Medicare claims, including $8 million for DME alone;

22 defendants in Detroit, Michigan, for $58 million in alleged false claims for medically necessary services;

a pharmacist in Tampa, Florida, for the alleged diversion of controlled substances; and

one defendant in Chicago, Illinois, for his alleged role in a plot to submit roughly $1 million in false billing to Medicare for psychotherapy services.

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