Friday, May 17, 2013

Granny Bird Award: Medicare Fraudsters

This edition of the Granny Bird Award, an award issued from time to time to those who harm the interests and benefits of the elders, goes to those who are fraudulently collecting money from Medicare.

From McClatchy DC:

Doctors, nurses and other licensed medical professionals were among 89 people recently arrested in nine cities, accused of scheming to defraud the Medicare program of nearly $223 million in false billings, the Obama administration announced Tuesday.

The defendants face charges of conspiracy to commit health care fraud, money laundering and violating federal anti-kickback statutes for submitting claims to Medicare for purchases, treatments and services that, according to federal officials, either were medically unnecessary or never provided.

In many cases, patient recruiters, Medicare recipients and others were paid cash to supply beneficiary information that later was used in billing scams, federal law enforcement officials said. Most of the alleged fraud involved home health care services, but the charges included mental health services, psychotherapy, physical and occupational therapy, durable medical equipment and ambulance services. ...

Over the past three fiscal years, every dollar spent fighting health care fraud has returned an average of nearly $8 to the U.S. Treasury and the Medicare Trust Fund, Holder said. But that success is threatened by the across-the-line federal budget cuts known as sequestration, which cut $1.6 billion from the Justice Department’s budget for the current fiscal year, he said.   [Emphasis added]

The illegal conduct was spotted by the Center for Medicare/Medicaid Services (CMS) primarily by a sophisticated computer program, but also by elders who checked the report from CMS each receives regularly and noted charges for goods and services they did not receive.  In other words, CMS is doing its job, but needs elders to do theirs as well.

While I am not Eric Holder's biggest fan, I do think the DOJ has been doing its job well in prosecuting Medicare fraud.  I hope the sequester is lifted soon so that we can continue to nail the sleazes who would rob the system so vital to elders.

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