Medicare fraudsters nabbed in $223 million nationwide bust

Federal authorities charged 89 people for false Medicare billings totalling $223 million Tuesday in one of the largest multistate raids to date. The sting operation focused on eight cities across the country (listed in order of charges) Miami, Detroit, Los Angeles, Houston, Brooklyn, N.Y., Chicago, Tampa, Fla. and Baton Rouge, La.

As fraud continues to evolve from double-billing and upcoding, several of Tuesday’s raids involved intricate schemes with trumped-up claims for medical equipment, identity theft, fake pharmacy prescriptions, and emergency transport scams, noted the Medicare Fraud strike force release.

Two doctors and three others in Baton Rouge, La., were accused of finagling ID numbers from legitimate Medicare beneficiaries and then billing them for $51 million in fraudulent home health services, many of which didn’t exist. A separate Baton Rouge operation involved $30 million in fraudulent mental health billing.

The Los Angeles stings revealed Medicare ID number scams and fraudulent power wheelchair prescriptions used for kickbacks. In Houston, home healthcare services were agian at the fore as a nurse and social worker teamed up to reap $8.1 million in bogus claims.

A raid in Detroit resulted in diverse schemes, including fake physicians, fake drug prescriptions and psychotherapy billing. Among those charged: two doctors, two therapists and a physician assistant. Four more doctors were charged in Chicago and Brooklyn. In Miami, two nurses and a paramedic were among those involved in a $44 million in false billing, including home healthcare services and HIV infusion therapy.

Health and Human Services (HHS) is attributing the growing success of raids to new computer software that uses predictive modeling technology to track patterns and anticipate fraudulent activity. “Today’s announcement marks the latest step forward in our comprehensive efforts to combat fraud and abuse in our health care systems,” U.S. Attorney General Eric Holder said in an HHS statement. “We will use every appropriate tool and available resource to find, stop and punish those who seek to take advantage of their fellow citizens.”


Topics: Advocacy , Executive Leadership , Medicare/Medicaid , Regulatory Compliance