89 Individuals Charged With About $233M in Alleged Medicare Fraud

On Tuesday, HHS Secretary Kathleen Sebelius and U.S. Attorney General Eric Holder announced that 89 health care and medical industry professionals -- including 14 physicians and nurses -- have been charged with allegedly defrauding Medicare of about $223 million through false billing, the AP/Washington Post reports (Kennedy, AP/Washington Post, 5/14).

Background

The new charges on fraudulent Medicare-related activities are the sixth in a series of government-led "takedowns" on health care fraud since 2010, officials said. "This is the latest sign that we're beginning to turn the tide of Medicare fraud," Sebelius noted at a news briefing (Viebeck, "Healthwatch," The Hill, 5/14).

Federal officials have projected that such fraudulent activity is costing Medicare between $60 billion and $90 billion annually. In 2009, the Obama administration announced the creation of the Medicare Fraud Strike Force, which would carry out coordinated investigations and crackdowns in regions known to be rife with Medicare-related fraud activity (AP/Washington Post, 5/14).

The Strike Force is part of the Health Care Fraud Prevention & Enforcement Action Team, a joint initiative between HHS and the Department of Justice. Since its inception, the Strike Force's operations -- in nine locations -- have charged more than 1,500 individuals for defrauding Medicare of more than $5 billion through false billing (HHS release, 5/14).

Latest Arrests

For the latest round of arrests, Strike Force agents identified suspects in Baton Rouge, La., Brooklyn, N.Y., Chicago, Detroit, Houston, Los Angeles, Miami and Tampa, Fla.

In Los Angeles, 13 individuals were charged for various scams totaling $23 million, while nearly 20 individuals in Detroit were charged for various scams totaling $12 million, the AP/Post reports.

Meanwhile in Miami, 25 individuals were charged for allegedly billing $51 million in home health services that were unnecessary or never provided (AP/Washington Post, 5/14).

Holder's Comments

During the news briefing, Holder noted that for each dollar that is spent on anti-fraud efforts, an average of $8 has been recovered for the U.S. Treasury and the Medicare trust fund. He said, "This takes our comprehensive fight against health care fraud to a new level," adding, "This work has yielded extraordinary results" ("Healthwatch," The Hill, 5/14).

However, he warned that the government's efforts to expand its anti-fraud initiatives are being affected by automatic across-the-board budget cuts under the sequester, which were enacted in March. For the fiscal year ending Sept. 30, DOJ's funding has been reduced by $1.6 billion, Holder said.

"Unless Congress adopts a balanced deficit reduction plan and stops the reductions currently slated for 2014, I fear our capacity to protect the American people from health care fraud ... will be further reduced," Holder said (Heavey/Morgan, Reuters, 5/14).