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Massive Medicare Fraud Takedowns

In what has been a heck of a month for new U.S. Attorney General Loretta Lynch, on the heels of the Justice Department’s headline-grabbing takedown and indictments of FIFA soccer officials, the DOJ, FBI, and U.S. Department of Health and Human Services (HHS) just announced the arrests of 243 individuals across the healthcare industry for Medicare fraud, including 46 doctors, nurses and other professionals. Companies that provide medical-related products and services were also implicated. The federal government uses robust false claims and anti-kickback laws to go after Medicare and Medicaid fraudsters who generally overbill for medical services or bill for fake or unnecessary procedures or treatments. The Patient Protection and Affordable Care Act of 2010 further strengthened some of these laws and provided more funding for the government to investigate and punish such violations. These programs insure the elderly and poor, generally speaking, and reimburse medical providers for treatment. This type of fraud is a direct financial assault on American taxpayers, and carries with it harsh civil and criminal consequences, including steep financial penalties and even jail time.

243 Arrests

The federal government’s Medicare Fraud Strike Force of federal agents including the FBI, DOJ, HHS and various U.S. attorneys offices, arrested 243 people across the country, including in 17 cities, for a total of about $712 million in false Medicare reimbursement claims. Authorities brought charges which included false claims, illegal kickbacks (such as where a medical provider receives a kickback or bribe from a company that makes drugs or certain equipment to choose that company’s products or push patients to use them), as well as even money laundering and identity theft. Medical providers submitted reimbursement claims for unnecessary equipment, overstated treatment times, and nearly four dozen were charged with offenses related to drug prescriptions.

For example, two companies sent mass-marketed talking glucose monitors to Medicare-insured patients regardless of whether the patients actually needed them, and billed Medicare for the costs of those machines. In another example, a single doctor was accused of fraudulently billing and referring $23 million in services as well as durable medical equipment such as wheelchairs that were not needed, and in some cases not even actually sent to the patients. There was also other fraud related to home health care, such as fraudulent billing for bogus or inaccurate doctor’s visits.

The Situation in Illinois

Illinois did not escape the scrutiny of the Medicare Fraud Strike Force, as twelve individuals were charged with fraud as part of this overall operation. The alleged fraud involved eleven personal assistants (or in-home care providers) submitting for reimbursements for unnecessary care or care they never actually provided to their patients/clients.

For example, one Medicare recipient was found covered in her own filth while her supposed personal assistant (and daughter) allegedly neglected her but still submitted reimbursement claims for her bogus services. Another care provider submitted claims for reimbursement when in reality her supposed patient was actually in prison at the time. The twelfth person was actually someone who received care and improperly sought reimbursement for ineligible services by claiming he could not drive to work when in fact he could.

This impressive coordinated action by federal authorities across the country shows the prevalence of fraud against American taxpayers, and which also adversely affects patients who need care but do not receive adequate levels. The need for enforcement is clear to protect the vulnerable, as well as the integrity of a vital source of healthcare funding, which many of us or our loved ones need.

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