Health fraud is big business
News coverage of the recent simultaneous arrests of 107 people in seven cities for alleged health care fraud pretty much appeared and disappeared in a day, at least outside Miami, Baton Rouge, Houston, Los Angeles, Detroit, Tampa and Chicago, the cities involved.
Behind the headlines, however, is a little-noticed law enforcement program that has focused exclusively on health care fraud, waste and abuse for 15 years. It’s worth taking special note of a joint federal, state and local collaboration that so far has recovered and returned more than $20 billion of taxpayer money to the Medicare Trust Funds and additional funds to other health care programs.
The indictments underpinning the operation by multiple federal, state and local agencies allege some $450 million in false Medicare billings. In addition to handling the arrests,the special Medicare Fraud Strike Force also suspended the Medicare participation rights of 52 health care providers and executed an additional 20 search warrants connected with other ongoing investigations.
According to HHS, the charges against those arrested in the seven-city operation were based on "a variety of alleged fraud schemes involving various medical treatments and services such as home health care, mental health services, psychotherapy, physical and occupational therapy, durable medical equipment and ambulance services."
Those arrested deserve fair trials and, if convicted, license revocations and prison time.
Contrary to stereotypes of high-living welfare queens and other supposed cheats, health care fraud strike force investigators -- working in the real world -- find large-scale fraud where the large-scale money is: on the provider side, not the consumer side. The indictments and supporting court documents named owners of health care companies and ambulance companies, doctors, nurses, licensed social workers, physical and psychological therapists and a pharmacist.
At 17 percent of America’s gross domestic product, health care is a big and complex a business, and most of its constituent parts operate honestly. But there’s so much money in play that would-be criminals seem endlessly creative and resourceful. Estimates of the annual cost of health care fraud range from $60 billion to $90 billion.
The enforcement work of the Health Care Fraud and Abuse Control Program pays dividends.