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Federal Government Charges 91 Individuals for Medicare Fraud

October 4, 2012
by Gabriel Perna
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The federal government’s push to curb Medicare fraud continued this week when Attorney General Eric Holder and Health and Human Services (HHS) Secretary Kathleen Sebelius announced that the multi-agency Medicare Fraud Strike Force operations have drawn charges against 91 individuals in seven states – including doctors, nurses and other licensed medical professionals.

The Medicare Fraud Strike Force, which uses federal, state and local investigators and prosecutors to combat Medicare fraud through the use of Medicare data analysis techniques, charged the parties for their alleged participation in Medicare fraud schemes involving approximately $429.2 million in false billing. According to HHS, dozens of charged individuals were arrested or surrendered in the last 24 hours as indictments were unsealed across the country.  Those indictments charge more than $230 million in home healthcare fraud; more than $100 million in mental healthcare fraud and more than $49 million in ambulance transportation fraud; and millions more in other frauds.

“Today’s arrests put criminals on notice that we are cracking down hard on people who want to steal from Medicare,” Sebelius said in a statement.  “The healthcare law gives us new tools to better fight fraud and make Medicare stronger.  In addition to the arrests made today, HHS used new authority from the healthcare law to stop future payments to many of the health care providers suspected of fraud, saving Medicare resources and taxpayer dollars from being lost to fraud in the first place.”

These charges come after Sebelius and Holder’s recent letter to various provider-based organizations, touting the federal government’s resolve to prevent EHR-related healthcare fraud. In the letter, Sebelius and Holder note that there has been “troubling indications” that some providers are using EHRs to “game the system,” and obtain payments, which they are not entitled.

The American Hospital Association (AHA), one of the targets of the original letter,responded and urged HHS to work with the hospital association to quickly develop national guidelines for the coding of emergency department and medical clinic visits.  There has also been public attention on the issue of potentially abuse coding in that area, as highlighted by a recent New York Times investigative report on the topic.

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