Massive Medicare Fraud Arrests Announced by Feds

The Justice Department has announced 243 arrests in connection with mass Medicare fraud.

Everybody from top to bottom involved.

$700 million.

The largest mass arrests to date.

With all these doctors and professionals involved, and given the wide areas involved, I think the medical industry fraud is highly organized.

Like Mafia.

And what about State Medicaid? I bet there's billion$ involved in fraud at those levels too.

Doctors, Nurses Among 243 Charged In Million-Dollar Medicare Schemes

Federal agents have arrested 243 people — including 46 doctors, nurses and other medical professionals — who are accused of running up more than $700 million in false Medicare billings. Charges range from fraud and money-laundering to aggravated identity theft and kickbacks.

Attorney General Loretta Lynch calls it "the largest criminal health care fraud takedown in the history of the Department of Justice."

Yes that's it!!! Greed is a sin, I'm waiting for September, so I can unchain the hounds.

a reply to: xuenchen

And these people will be punished how? Loss of license? Leave without pay?

a reply to: iDope

don't know but well if this is any indication:

www.justice.gov...

well I think it will be some prison time if they are found guilty?

a reply to: dawnstar

We can only hope that they get prison time for their actions, obviously some less than others. From the OP it seems as if they were targeting Medicare,

In 2010, Medicare provided health insurance to 48 million Americans—40 million people age 65 and older and eight million younger people with disabilities. It was the primary payer for an estimated 15.3 million inpatient stays in 2011, representing 47.2 percent ($182.7 billion) of total aggregate inpatient hospital costs in the United States.

And Some further information from the OP article that stand out to me:

One California doctor is accused of causing nearly $23 million in fraud losses through illegal practices that involved "over 1,000 expensive power wheelchairs and home health services that were not medically necessary and often not provided."

AND a major statistic in less than 10 years,

Since it was formed in 2007, the Medicare Fraud Strike Force has "charged over 2,300 defendants who collectively have falsely billed the Medicare program for over $7 billion," the government says. It adds that in that same span, the strike force has prosecuted more than 200 doctors and more than 400 medical professionals.

Is this going to ruin Medicare? Is it going to cause more legislation in the hospitals (Even after Obamacare)? Will patients have the right to see their medical records and sign off on them before sent to insurance? What preventions can be in place to hinder these actions? There are so many problems with the current system that it makes me really question so many different aspects.

Think about all the insurance companies that you see advertise on TV and all types of media. They are making huge bank on something as simple as insurance. These doctors know that, they know the system, and feeding off of all the elderly that swarm the hospitals is an easy prey.

a reply to: xuenchen


One of my specialists told me last month that the major hospital in our county paid a $25MILLION fine for Medicare fraud quietly under the table so no one would know. They apparently had to pay a % of their gross receipts, which means they made $25BILLION with a "B". No one will be fired or jailed.

Think about it: 46 doctors, nurses and other medical professionals... out of 243 arrested.

So, the other 197 are involved in what way?

I didn't even click the article, which I will. But I am willing to bet cash money most of the fraud is in CALIFORNIA.

Am I right? Did I win something? Am I wrong?

a reply to: xuenchen

With all these doctors and professionals involved, and given the wide areas involved, I think the medical industry fraud is highly organized.

Why do you think it is "highly organized?" The cases mentioned in the article show no indication of an organized effort. Nor does the system require an organized effort to commit fraud.

a reply to: iDope
Medicare insurance companies send out reports on a monthly basis of the charges they've paid, what the patient owes, etc. They constantly run ads on radio telling people to check the reports.
Here's the problem: You pretty much need a med-tech coding degree to understand the statements. And even if you can make out that something is amiss, and if you take the time and effort to report what you consider fraud? Calling the number listed on the statement gets you an automated call center. Spending twenty minutes going through each and every option on that system does not give you a choice to "Report Fraud." If you take the time and effort to type, print out and mail a letter to the address listed on the statement, you never get a response.
In the case with which I'm familiar, it was less than $200 collected but it could not have been a "coding error." The patient was indeed in the office that day but due to an error by the appointment clerk did not get any sort of medical care yet was billed for two procedures. (The two that should have been done.) Two weeks later the same charges were made when the procedures actually were completed.
Most folks will say, "Hey, it's only a tiny amount of money in the grand scheme of doc's salaries, right?" But I think about it this way; say he does this once or twice a week, adds a procedure or two that he didn't perform? Over a month's time, it adds up to a nice boat or car---in our town. If only 2% of the dozens of docs in that building are padding just that much, it will add up to millions quickly.
Apparently, they aren't interested in really rooting out the fraud, they're just interested in getting a few big busts so they can dust their hands and say, "See what we've done!"

originally posted by: Phage The cases mentioned in the article show no indication of an organized effort. Nor does the system require an organized effort to commit fraud.

People in the medical practitioner field can only do so much; they often rely on back end people to interface with the "system" in place, whichever it is. If these practitioners' claims against Medicare were approved and paid at some higher level, that suggests insider involvement... or at least ignorance at the highest levels.

Considering only 1/5 of the arrested were practitioners, there had to be some inside in some way, shape or form.

So you, sir Phage, unless you have evidence to the contrary... you should take the advise you gave me a while back: GO AWAY!

a reply to: paradoxious

or at least ignorance at the highest levels.

Perhaps.
More likely unconcern. "Not my problem."
Not uncommon in a bureaucracy.

So you, sir Phage, unless you have evidence to the contrary... you should take the advise you gave me a while back: GO AWAY!

No sir, thank you. But you are asking for evidence that something did not occur?

The FBI is starting to crack down hard.Sign up to FBI.gov alerts to see all the recent high profile arrests made..

So for those that think they can break the law and get away with it think again.This goes for politicians as well.

In 2010, Medicare provided health insurance to 48 million Americans—40 million people age 65 and older and eight million younger people with disabilities. It was the primary payer for an estimated 15.3 million inpatient stays in 2011, representing 47.2 percent ($182.7 billion) of total aggregate inpatient hospital costs in the United States.

a reply to: iDope

So if Medicare is paying or 47% of the inpatient hospital costs I can only wonder just what percentage the gov't contributes through all it's programs to healthcare costs in the US
or better, what percentage is being paid by those not relying on those programs and their non-gov't subsidized insurance policies, who are probably being fleeced also

to end medicare and the other gov't programs would probably kill our healthcare system since they are probably generating over 50% of the revenues for the providers.