Part B Insider (Multispecialty) Coding Alert

Published on Fri Oct 08, 2010 PDF

The feds have taken down one of the huge Medicare fraud schemes of the type that is making your life harder. Law- and policy-makers have been issuing new compliance rules based on the crimes like those allegedly committed by an organized crime syndicate. Seventy-three defendants were charged in indictments unsealed Oct. 13 in five judicial districts with various health care fraudrelated crimes involving more than $163 million in fraudulent billing, says the Department of Justice, FBI, and OIG in a release.

The defendants allegedly stole the identities of doctors and thousands of Medicare beneficiaries and operated at least 118 different phony clinics in 25 states, the release says. The criminal operation is "the largest Medicare fraud scheme ever perpetrated by a single criminal enterprise and charged by the Department of Justice."

"The emergence of international organized crime in domestic health care fraud schemes signals a dangerous expansion that poses a serious threat," said Acting Deputy Attorney General Gary G. Grinder in a statement. "These syndicates are willing to exploit almost any program, business or individual to earn an illegal profit."

Fifty-two arrests for the fraud scheme occurred in five states -- California, Georgia, New Mexico, New York, and Ohio, the DOJ said. "We want to restore the confidence in the nation's health care system and assure practitioners we will not stand by and let their identities be used for criminal gain," Kevin Perkins, FBI Assistant Director of the Criminal Investigative Division, noted in the release.