This past week it was announced that there was a nationwide sweep led by the Medicare Fraud Strike Force resulting in charges against 243 individuals, including 46 doctors, nurses and other professionals, for their alleged participation in Medicare fraud schemes involving approximately $712 million in false billings. According to the announcement, the Centers for Medicare & Medicaid Services (CMS) also suspended a number of providers using its suspension authority as provided in the Affordable Care Act collectively resulting in the largest coordinated takedown in Strike Force history.
The list of various health care fraud-related crimes the defendants are charged with, include:
- Conspiracy to commit health care fraud
- Violations of the anti-kickback statutes
- Money laundering
- Aggravated identity theft
These charges are based on a variety of alleged fraud schemes involving various medical treatments and services, including home health care, psychotherapy, physical and occupational therapy, durable medical equipment (DME) and pharmacy fraud.
The announcement goes on to say that the defendants participated in alleged schemes to submit claims to Medicare and Medicaid for treatments that were medically unnecessary and often never provided. In many cases, patient recruiters, Medicare beneficiaries and other co-conspirators allegedly were paid cash kickbacks in return for supplying beneficiary information to providers, so that the providers could then submit fraudulent bills to Medicare for services that were medically unnecessary or never performed.
According to HHS-OIG Inspector General Levinson, "Health care fraud drives up health care costs, wastes taxpayer money, undermines the Medicare and Medicaid programs, and endangers program beneficiaries." Inspector General Levinson made it clear, "this record-setting takedown sends a message to would-be perpetrators that health care fraud is a risky way to line your pockets. Our agents and our law enforcement partners stand ready to protect these vital programs and ensure that those who would steal from federal health care programs ultimately pay for their crimes."
This announcement should serve as an important reminder that the CMS is working with the Office of the Inspector General (OIG) to take steps to increase accountability and decrease the presence of fraudulent providers. To ensure you are up to date on CMS and OIG regulations, we highly recommend organizations taking advantage of customizing their corporate compliance program and providing employee training on this program if you are not already.
If you have any questions or concerns about health care fraud, or would like more information about our corporate compliance program, please feel free to comment below, send us an email at [email protected], or reach us toll-free at 855-427-0427.