The largest healthcare fraud take-down in the history of the United States occurred this month. 243 people were arrested and charged for committing false Medicare billing. The arrests were spread across 17 cities throughout the country and were part of a joint effort by the FBI, the Department of Health and Human Services, the Department of Justice, and local law enforcement agencies.
“Strike” Teams are Going After Healthcare Frauds
The effort began as a means to combat the growing amount of false reporting on medical bills. Officials say that the number of cases of healthcare fraud and abuse is growing at a startling rate. Members of the FBI noted that doctors, nurses, and many other medical professionals have been involved in these schemes. It is estimated that these recent arrests accounted for over $700 million in false billings.
The majority of the cases in question involved clinics and doctors’ offices reporting on procedures or treatments that were either not necessary or not actually performed. They involved recipients of Medicare working in coordination with health care providers to give fraudulent information to Medicare. These conspirators often received cash benefits as a result of their cooperation, which incentivized both sides of the transaction.
Criminals have been targeting Medicare for a number of years. Strike teams similar to the ones in the most recent arrests have been in operation since 2007. They have reported on nearly $7 billion in false Medicare bill and have charged more than 2,300 people in these cases.
New Orleans was one of the cities targeted by the Strike Force. Four people operating in New Orleans were charged with sending glucose monitors to people throughout the country regardless of whether they were needed or requested. The operators of this scheme billed Medicare a staggering $38 million dollars for these monitors and received $22 million in payment. Cases like these are becoming more common throughout the country. One person in Houston was charged with helping Medicare beneficiaries determine exactly what they needed to say in order to qualify for treatments covered by Medicare. This person then split the Medicare benefits with the patient receiving them. In the end, they collected over $4 million of Medicare claim money.
$10 Billion/Year of Fraud
Health care fraud is estimated to cost the United States more than $10 billion every year. The numbers could be even higher, but it is tough to account for the copious amounts of fraud that occur everyday. The United States spends roughly 3$ trillion on health care every year and that number continues to grow. The most alarming result of the ample health care fraud being seen throughout the nation is that more and more doctors are willing to risk patient safety for the benefit of the conspiracy. The lavish schemes can be so lucrative for doctors that they forego their primary duty as a caregiver and assume the role of con man.
The FBI hopes to continue its successful track record for stopping these healthcare fraud schemes. The strike force teams utilized more than 900 members of law enforcement to execute the arrests. The Department of Justice is estimated to have recovered over $3 billion in fraudulent Medicare claims. The FBI will continue to use these strike force teams to recover lost money and prevent other health care fraud schemes from taking place.