In March 2007, agencies within the Department of Justice teamed with the Department of Health and Human Services to establish the Medicare Fraud Strike Force. The strike force is part of a larger initiative known as the Health Care Fraud Prevention and Enforcement Action Team. H.E.A.T., as the team is affectionately known, has two-dozen prosecutors in nine U.S. cities. To date the strike force has taken down more than 1,300 people accused of Medicare billing fraud totaling as much as $4 billion in fiscal year 2011 alone.
The breaking story last week was a wide sweeping bust of 107 doctors, nurses and social workers who allegedly defrauded the Medicare system of $452 million by submitting bills for medical services and expenses that were never rendered.
It was the latest in a string of major arrests in the past two years as authorities have targeted fraud that’s believed to cost the government between $60 billion and $90 billion each year. Stopping Medicare’s budget from hemorrhaging that money will be key to paying for President Barack Obama’s health care overhaul.
Health and Human Services Secretary Kathleen Sebelius and Attorney General Eric Holder partnered in 2009 to increase enforcement by allocating more money and staff and creating strike forces in fraud hot spots.
The full story is available on Business Week.
This week saw even more fraud uncovered when the “Suspicious Medicare billings found at 2,600 drugstores” story broke with a full report and strongly worded recommendations from the HHS inspector general.
The new report by the inspector general of the Health and Human Services department finds the corner drugstore is vulnerable to fraud, partly because Medicare does not require the private insurers that deliver prescription benefits to seniors to report suspicious billing patterns.
“While some pharmacies may be billing extremely high amounts for legitimate reasons, all warrant further scrutiny,” said the report being issued Thursday.
The analysis broke new ground by scrutinizing every claim submitted by the nation’s 59,000 retail pharmacies during 2009 — more than 1 billion prescriptions. Using statistical analysis, investigators were able to reveal contrasts between normal business practices and potential criminal behavior.
“The findings call for a strong response to improve (program) oversight,” the report said.
Websites where you can learn more:
- “Feds Fight Rampant Medicare Fraud in South Florida” by NPR’s “All Things Considered“, November 6, 2007
- “Medicare fraud rampant in South Florida”, by The Miami Herald, August 3, 2008
- “Senior-citizen volunteers fighting Medicare fraud” by the Associated Press, December 29, 2009
“52 arrested in sweeping Medicare fraud case” by The Los Angeles Times, October 14, 2010
- “111 charged with Medicare fraud in 9 cities” by The Washington Times, February 17, 2011
- “Rockwall doctor accused of fraud has long history of patient harm” by The Dallas Morning News, February 28, 2012