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Criminal Crack Down on Medicare Fraud

A joint federal task force arrested 94 people – many of them doctors – in a recent crackdown on Medicare fraud throughout five major cities in the United States. Prosecutors claimed that physicians, health care executives and others in four cities received $251 million in false Medicare claims. Included among the federal criminal charges were conspiracy to defraud the Medicare program, violations of anti-kickback statutes, money laundering, criminal false claims and creating other false schemes.

In Miami, Florida, two dozen people were charged for their participation in a scheme that included fraudulent billing for HIV infusion services. Prosecutors said that the schemes involved recruiting patients to bill for services never rendered, including home health care and physical therapy.
In Brooklyn, New York, nearly two dozen people were charged with submitting a total of $78 million in fraudulent claims for physical and occupational therapy. Six defendants were said to be “serial” beneficiaries – people who continually submit claims for services never rendered.

In Houston, Texas, four people were charged for their roles in a $3 million scheme involving fraudulent claims for durable medical equipment.
Inspector General of Health and Human Services, Daniel R. Levinson, noted that the arrests “illustrate how health care fraud schemes can replicate virally and migrate rapidly across communities.” Most startling to prosecutors is the involvement of physicians, whose participation is often crucial to many of the Medicare schemes. In one case, three physicians signed off on examinations finding ailments that never existed, but billing Medicare for them.

The U.S. government spends roughly $600 billion on Medicare and Medicaid each year and has a huge bureaucracy behind it, making it an attractive target to defraud. According to Nightline, Medicare fraud results in $60 billion in losses each year.

Since 2007, the federal task force has charged 810 people with defrauding the government of nearly $2 billion in phony Medicare claims. Given the billions lost to fraud, the federal task force, which included the FBI, focused its efforts to investigate and prosecute anti-fraud laws in the U.S. and save taxpayers billions.