Medicare Fraud Strike Force Widens Scope

The Department of Justice (DOJ) and Health and Human Services (HHS) announced Dec. 15, 2009 expansion of Medicare Fraud Strike Force operations to Brooklyn, Tampa, and Baton Rouge.

“Along with teams already operating in Miami, Los Angeles, Houston and Detroit,” said HHS Secretary Kathleen Sebelius, “these Strike Force operations will allow us to concentrate our agents and resources on the criminal hubs where we know a significant share of fraud occurs.”

On the same day, 30 people were charged in Miami, Detroit, and Brooklyn for their alleged roles in schemes to submit more than $61 million in false Medicare claims. And Strike Force agents executed four search warrants at businesses and homes in Coconut Creek, Fla., Miami, and Brooklyn.

Since operations began in March 2007, the Strike Force has obtained indictments of more than 460 individuals and organizations that collectively have falsely billed the Medicare program for more than $1 billion.

Source: HHS press release; DOJ press release.

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4 Responses to “Medicare Fraud Strike Force Widens Scope”

  1. Karen Wolmer says:

    This is one of the biggest jokes! What a waste of taxpayer dollars. I know of physicians which were reported for fraud and to date, the OIG, the FBI, the Department of Justice has done nothing. Even with hard core proof, they are not investigating. Where are the recovery audit centers in CT? They were supposed to be in CT by August 2009 and they are not here. With Obama’s new healthcare reform you’d think that the government would want to recoup these dollars. If and when this new reform takes place the physicians will never receive the monies they deserve for services rendered. Federally Qualified Health Care Centers will boom. It is unfortunate that the physicians committing an act of fraud will never be brought to justice and the physicians struggling, doing there documentation correctly will suffer. Shame on the government for allowing this to take place.

  2. Pawan Arya, MBA, CMPE, CPC, CPC-H says:

    Karen,

    While your frustration is understandable, but you seemed to have missed “Since operations began in March 2007, the Strike Force has obtained indictments of more than 460 individuals and organizations that collectively have falsely billed the Medicare program for more than $1 billion.”

    Soon law will catch up with those commiting fraud. The more time it takes, deeper they will be into fraud and more severe will be action against them. At least that is what I think.

  3. Judith A. Hale, CPC says:

    Pawan, you are absolutely correct. I have repeatedly reported (as has another family caretaker) an attending physician in a skilled nursing home for upcoding. She “gangs” her visits, sees each patient for less than one minute, has no PA or MA with her, provides no medical documention for her visits, and codes every visit to the highest code E/M code for nursing home visits. It does not matter to her whether the patient is bedridden with a feeding tube or playing bingo and attending yoga classes. Everyone is a 99310. This is blatant upcoding and supplements her income by several thousand dollars per year. She has been reported to OIG, the Medicare Fraud Division, and the FBI. While DME cases are a slam dunk, no one seems to want to touch a single M.D. case that will take some digging. Trust me, this is not an isolated case. Nursing homes are ripe for the pickings, and I would be willing to bet that this problem is systemic throughout skilled facilities. There are not enough auditors and many of them are simply not qualified to do the job (the FBI: clueless). Obama said his new heath care plan will be paid for in a large part by ferreting out Medicare/Medicaid fraud and abuse. A recover of one billion dollars is a drop in the bucket to support Obama’s multi-trillion dollar plan. More government dollars for auditors to chase their tails? A crime unto itself.

  4. Judith A. Hale, CPC says:

    Oops, I meant I agreed with Karen. No disrespect intended toward’s Pawan’s response.

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