On June 22nd, 2016, Attorney General Loretta E. Lynch and Secretary Sylvia Mathews Burwell of the Department of Health and Human Services, DHHS, published a press release announcing that the Department of Justice Medicare Fraud Strike Force was successful in a takedown that is unprecedented in history. Thirty-six federal districts participated in a nationwide sweep that resulted in charges against 301 people. Of those, 61 were licensed medical professionals, including doctors and nurses.
Lynch stated in the release, “As this takedown should make clear, health care fraud is not an abstract violation or benign offense – It is a serious crime,” said Lynch. “The wrongdoers that we pursue in these operations seek to use public funds for private enrichment. They target real people – many of them in need of significant medical care. They promise effective cures and therapies, but they provide none. Above all, they abuse basic bonds of trust – between doctor and patient; between pharmacist and doctor; between taxpayer and government – and pervert them to their own ends. The Department of Justice is determined to continue working to ensure that the American people know that their health care system works for them – and them alone.”
The cases involve millions of dollars that were allegedly fraudulently charged to Medicare. In the Southern District of Texas, 22 individuals were charged. One case involves a Houston physician, John Ramirez, and Milton Clinic billing Medicare for unnecessary home health services and selling home health agencies signed certifications. Those home health agencies would then bill for services that were either not necessary, were never provided, or both. The press release states that this case was an $18 million scheme. The same physician was charged in a second $20 million scheme for the same fraudulent behavior.
In other fraudulent schemes, a number of individuals were charged for billing for the most expensive size diapers, whether that size was used or not; submitting claims for equipment that was not provided to the patient, equipment that was not authorized by a physician, forging physician signatures, taking cash kickbacks for patient information, and providing services that were not needed.
The Medicare Fraud Strike Force was created in 2007 and has offices in nine states. According to its website, as of June 30, 2016, the Strike Force has been involved in 1,522 criminal actions and obtained 2,185 indictments and recovered $1.98 billion. According to the press release mentioned above, since 2007, the Strike Force has charged more than 2,900 individuals that fraudulently billed Medicare $8.9 billion.
It appears that the Strike Force is working hard to bring those who attempt to defraud the Medicare program to justice. It is disheartening to think that our medical care providers would take advantage of our illnesses and taxpayer money to pad their own pockets. Especially way over and above anything they could possibly deserve for their services.
As citizens, we can do our part to help stop Medicare fraud. If you suspect that fraud is occurring, go to the Medicare Fraud Strike Force website and following the directions you will find on that page.