Largest Medicare fraud Bust (Anyone can be a criminal)

A nationwide law enforcement crackdown resulted in charges against 91 people including doctors and other medical professionals  for what authorities described as the largest bust for Medicare fraud in U.S. history, allegedly participating in schemes involving $295 million in false billing.

“At various positions, nurses and physicians violated their professions as well as the public trust,” Attorney General Eric Holder told reporters, saying that charges included kickback schemes and money laundering.

The charges are based on a variety of alleged fraud schemes involving various treatments and services that were not medically necessary – and, oftentimes, were never even provided.

Eleven of the people charged were doctors, three were nurses and 10 were licensed health professionals. $160 million of the total in phony claims announced  came from South Florida, still leading the nation in Medicare fraud.

In Miami, U.S. Attorney Wifredo Ferrer said investigators noticed a new twist in which people who already were receiving Medicare disability checks were recruited with promises they could live in a halfway house in South Florida — as long as they agreed to receive mental health services they did not need. Many were addicted to drugs or alcohol, and some were homeless, and Ferrer said they would be threatened with eviction if they did not participate in the fraud scheme.

That particular scheme and other frauds, operated out of an entity called Biscayne Milieu, accounted for $50 million of the fraudulent Medicare claims, prosecutors said. It provided no legitimate services.

In Houston, two people were charged with fraud schemes involving $62 million in false claims for home health care and medical equipment. One defendant allegedly sold beneficiary information to 100 Houston-area home health care agencies. The home agencies used the information to bill Medicare for services that were unnecessary or never provided.

In Baton Rouge, La., a doctor, nurse and five other co-conspirators were charged with billing Medicare more than $19 million for skilled nursing and other home health services that were not necessary or never provided.

Just goes to show that even when you go for a check-up make sure you are getting charged for services you actually received.



3 thoughts on “Largest Medicare fraud Bust (Anyone can be a criminal)

  1. It is clear to me that medicare needs some more oversight, but I am not sure if it is just fraud that is costing the taxpayers money. Last year I needed some eye drops, so I stopped by Wegmans to pick up my perscription. At Wegmans, these drops would cost me 80 dollars, because they were covered by Insurance. Those same drops cost only 11 dollars if purchased at RIT’s Health Center. Why does Wegmans charge so much? Since the insurance company pays for the medicine, people don’t notice how much it costs them directly. I can’t help but feel that most medication is sold this way, so that organizations such as medicare are forced to use taxpayer dollars to pay ridiculous prices on medication.

  2. Pingback: Medicare Buz » Blog Archive » Can I receive Medicare or Medicaid benefits at the same time as I receive Social Security disability benefits?

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