In what’s being called a “nationwide takedown” by Medicare Fraud Strike Force operations, charges have been filed against 90 individuals who allegedly submitted over $260 Million in false claims to Medicare. The individuals charged with the fraud include 27 doctors, nurses and other medical professionals in six cities across the nation.
This is the seventh coordinated takedown by the Strike Force since it began in 2007. Its operations are part of the Health Care Fraud Prevention & Enforcement Action Team (HEAT), a joint initiative of the U.S. Department of Justice & HHS.
Most of the charges relate to billing for services that were either never provided or unnecessary. Also interesting to note is that in addition to such criminal activity being fraudulent, in most cases there were HIPAA violations yet HHS has chosen to prosecute on the fraud charges, which sends a message to health care organizations that if you participate in fraud, you will get caught.
More details about the individuals charged in their most recent takedown can be found in the HHS press release here.
Previously government continued to issue Medicare payments to suspected fraudsters, which has been cited by HHS as a major weakness in prior Strike Force Actions. In 2012, with the passage of the Affordable Care Act, HHS now has the authority suspend payment when suspected fraud is identified.
“The Affordable Care Act has given us additional tools to preserve Medicare and protect the tens of millions of Americans who rely on it each day,” said HHS Secretary Kathleen Sebelius in the press release about the fraud schemes. “By expanding our authority to suspend Medicare payments and reimbursements when fraud is suspected, the law allows us to better preserve the system and save taxpayer dollars. Today we’re sending a strong, clear message to anyone seeking to defraud Medicare: You will get caught and you will pay the price. We will protect a sacred trust and an earned guarantee.”
Medicaid and Medicare fraud is a huge issue for health care organizations. Fraud comes in all forms, with false Medicaid claims being one of the most common. This is why a robust auditing program is necessary. In most of the cases in this recent takedown, we suspect that the business owners were corrupt.
According to the Strike Force’s website, the government has recovered more than $10 billion in the last three years thanks, in part, to health care reform and recent steps taken to fight fraud, waste and abuse.
Are you taking the necessary steps to make sure that your organization is safe from fraud?
