California Healthline, Friday, June 19, 2015

Nearly 250 people, including 46 providers, were charged with falsely billing Medicare a total of nearly $712 million, federal officials announced Thursday, the Wall Street Journal reports.

U.S. Attorney General Loretta Lynch said it represented the “largest criminal health-care fraud takedown in the history of the Department of Justice” (Barrett, Wall Street Journal, 6/18).

The cases are being handled by the Medicare Fraud Strike Force, which has charged more than 2,300 people accused of falsely billing Medicare more than $7 billion since it was established in 2007. The Affordable Care Act bolstered the strike force with $350 million in additional funding (Bernstein/Horwitz, Washington Post, 6/18).

Federal officials said the arrests were aided by increasingly sophisticated computer programs that scan billing data for potential fraud (Wall Street Journal, 6/18). FBI Director James Comey said investigators “followed the money” to uncover individuals who saw Medicare as “an ATM that was a freebie to them but is actually filled with taxpayers’ money” (Washington Post, 6/18).

Details of Charges

Lynch said the individuals who were charged were “billed for equipment that wasn’t provided, for care that wasn’t needed and for services that weren’t rendered” (Alonso-Zaldivar, AP/Washington Post, 6/18).

For example, federal officials charged:

  • Three owners of a hospice service in Detroit who allegedly paid kickbacks for referrals from two physicians who wrote medically unnecessary prescriptions;
  • Two home health care companies in New Orleans that allegedly billed Medicare $38 million for glucose monitors they sent to patients regardless of medical need; and
  • Administrators of a mental health center in Miami that allegedly paid kickbacks to owners of assisted living facilities and patient recruiters (Department of Justice release, 6/18).

More than 44 of the 243 suspects allegedly defrauded Medicare Part D, marking the first major crackdown on fraud of the prescription drug benefits program for seniors.

Thursday’s announcement could signal that the government is set to more aggressively fight Medicare Part D fraud, according to Jessica Gustafson, a lawyer from the Health Law Partners (Schenker, Modern Healthcare, 6/18).

Source: California Healthline, Friday, June 19, 2015