Federal investigators recently did the biggest takedown in Medicare task force history. They charged nearly 100 people in eight different cities with attempting to fraud the Medicare program. Part of the health care reform laws include stronger anti-fraud laws.
The Obama administration has enacted many changes on health care reform. Some of those changes include an increase in efforts to catch people who have attempted to commit insurance fraud. According to Health and Human Services Secretary Kathleen Sebelius, the fraud law that was created as part of the health reform laws is “one of the strongest anti-fraud laws in history”.
What is new about this version of the insurance fraud law? There are now longer prison terms for people who commit fraud than there used to be. There are more people working on the strike force teams that go after people who commit fraud. New technology is being used by investigators that allows them to see claims “in real time”, which helps them to see patterns before those bills are paid.
There was a coordinated nationwide strike that went after people who tried to fraud Medicare. The types of fraud the task force went after included: money laundering, and providing “kickbacks” to people who gave out Medicare beneficiary numbers (to name just a few things). The majority of the fraud was from people who billed Medicare for home health care that was not provided, or for durable medical equipment that was not used by patients.
There was one situation where a person threatened a Medicare recipient, saying that the person would lose his or her housing if they didn’t participate in a Medicare scheme that was going on in Miami. Overall, there were 91 people who were charged with attempting Medicare fraud that totaled to around $295 million. Some of the instances of fraud are truly shocking.
There were forty-five people in Miami that caused a total of $159 million in Medicare fraud. These people made false billings for things like home health care, mental health care, durable medical equipment (such as electric wheelchairs), physical therapy, and HIV infusion.
One person had a home health care business that was paying kickbacks to patients who agreed to say that they received care that they actually never received. Two people in Houston caused around $62 million in fraud for false billings for things like home health care, and durable medical equipment.
A doctor in Detroit was rather creative in his fraud. He was billing patients for the psychotherapy treatments he supposedly provided them with, for more than 24 hours a day. He was also billing patients who were deceased. I’m not sure how one would go about attempting to psychoanalyze the dead. Perhaps this is what tipped off the fraud task force.
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