Elaborate Medicare Fraud Schemes Rob Taxpayers and Patients

By: Meredith Taylor, Esq., CIS Senior Compliance Manager
meredithtaylor@cis-partners.com

Medicare waste, fraud, and abuse are running rampant in our country and costing taxpayers billions of dollars a year. The ultimate price to be paid, however, is the deteriorating medical care provided to seniors and the disabled. In his February 24, 2009 address to Congress, President Obama acknowledged this problem and pledged to “root out the waste, fraud, and abuse in our Medicare program” through comprehensive healthcare reform.[1]

The U.S. Department of Health and Human Services, along with the U.S. Department of Justice, investigates and prosecutes fraudulent Medicare claims. With the assistance of state investigators, this “multi-agency team of federal, state and local investigators is generating results.”[2] The following examples are some of the most current fraudulent Medicare schemes that were identified, investigated, and prosecuted (or are being prosecuted) by the Government.

On February 13, 2009, six employees at a Miami clinic, claiming to specialize in treating HIV/AIDS patients, were indicted in a $10 million Medicare fraud scheme. Three doctors and other clinic employees ordered infusions and injections for patients who they claimed, through false medical records, were HIV positive. In some cases, the infusions were ordered but never provided. The doctors and clinic employees also manipulated HIV positive blood samples in order to make it appear that the patients had certain HIV-related conditions warranting particular treatments. The doctors and clinic employees billed over $10m to Medicare for unnecessary services, and for services that were never provided, over the course of three years. This case is currently pending in Florida’s Federal court.[3]

On February 19, 2009 in Dallas, the owner of a medical equipment supplier was sentenced to five years in prison and fined $132,955.35 for Medicare fraud. The supplier paid a hospital employee for information on Medicare patients, then sold that information to other medical equipment suppliers. These suppliers used the information to submit Medicare reimbursement forms, claiming that wheelchairs were provided to the patients. The 200 false claims indicated that the patients had prescriptions for the wheelchairs, when they did not, and cost Medicare over $804,344.42.[4]

On February 9, 2009, a business owner and his daughter admitted to falsely billing Medicare on behalf of his company for counseling services made to patients in personal care homes. In fact, these counseling services, in the amount of $67,000, never took place. Once the investigation began, the business owner created false records to try to persuade investigators that the services were rendered. These fraudulent billings could lead to a sentence including a $500,000 fine, and imprisonment for up to 18 years.[5]

On February 26, 2009, a doctor in California pled guilty to administering less than the prescribed dosage of drugs to AIDS patients. He then billed his patients' health insurance providers for the full dose of the drugs, even when patients were no longer taking the drugs, and billed for doctor administration when patients were self-administering the drugs. This doctor estimated that he fraudulently billed Medicare for approximately $350,000, but the Government estimates the fraudulent amount to be closer to $660,955. This doctor is currently awaiting his sentence. [6]

On February 24, 2009, a man in Florida was sentenced to 28 years in prison as a result of healthcare related fraud and money laundering. This man submitted $5.4 million dollars in claims for durable medical equipment over the course of two years. Medicare paid approximately $1.3 million of the claims. The investigation revealed that the medical equipment was never prescribed, or provided, to any patients.[7]

These are only a few examples of the elaborate schemes providers, suppliers, manufactures, and individuals have concocted to defraud Medicare. President Obama is certainly on point with highlighting blatant Medicare fraud as an enormous waste of taxpayers’ money that must be stopped immediately. I look forward to learning more about his plan!

Sources:
[1] http://medicareupdate.typepad.com/medicare_update/2009/02/medicarereform.html
[2] http://www.hhs.gov/medicarefraud/
[3] http://www.usdoj.gov/opa/pr/2009/February/09-crm-122.html
[4] http://www.usdoj.gov/usao/txn/PressRel09/sanders_hcf_sen_pr.html
[5] http://www.usdoj.gov/usao/kyw/press_releases/PR/20090209-01.html
[6] http://www.usdoj.gov/usao/cac/pressroom/pr2009/018.html
[7] http://www.usdoj.gov/usao/fls/PressReleases/090225-01.html