Largest Medicare fraud case nets 114 offenders

By Dr. Ananya Mandal, MDFeb 20 2011

In one of the largest healthcare fraud cases, the U.S. government last Thursday charged 114 doctors, nurses and other defendants with Medicare crime schemes that exceeded $225 million in false billings.

The charges in the latest of a series of cases were announced by Attorney General Eric Holder and Health and Human Services Secretary Kathleen Sebelius. In fact critics warned that the 45 million elderly and disabled Americans who are enrolled in taxpayer-funded Medicare plans are subject to this fraud. Medicare reform represented a key part of the sweeping year-old health care law championed by Democratic President Barack Obama, but opposed by many Republicans in Congress.

These new charges have accused defendants in nine cities. In addition to arrests, law enforcement agents also executed 16 search warrants. The defendants were charged with crimes like conspiracy to defraud the Medicare program, false claims, kickbacks and money laundering, administration officials said. They added that the alleged schemes involved various medical treatments, tests and services, such as home health care, physical and occupational therapy and medical equipment.

Holder said, “Although today marks a critical step forward in combating and deterring illegal activity, our work is far from over.” He added that fraud has accounted for as much as an estimated $60 billion a year in the Medicare program. According to FBI official, Shawn Henry, 2,600 health care fraud cases were under investigation and that organized crime groups have been increasingly linked to the alleged schemes.

Sebelius revealed that $4 billion was recovered last year and the government’s Medicare Fraud Strike Force was recently expanded to nine cities, with the addition of Dallas and Chicago. The nine cities included Los Angeles, Brooklyn, Detroit and Miami. Ms. Sebelius said, “Prosecution is important after the fact… What we’d like to do is also set up much higher firewalls before the fact and actually stop this money from going out the door.”

She added that the health-care overhaul passed last year now provides new support for fraud-prevention efforts. She said the agency was setting up new checks to screen providers before they are accepted into the system and building data systems that gather all billing information into one place, “which has never been available before.”