Not many dispute Medicare is subject to fraud and Medicare fraud is a significant matter. Health care experts estimate that roughly 10-percent of Medicare funds are lost to fraud — and the total is around $16 billion. The money which could be funneled to health care for seniors is going into the pockets of con men who are taking advantage of a bloated system.
The front line if battling Medicare fraud are whistleblowers. They know the practices as those who defraud the government try to hide their misdeeds from the public eye. Whistleblowers are critical to uncovering the facts.
The False Claims Act (FCA) may be the most powerful whistleblower rules on the books. The FCA permits whistleblowers to bring cases on behalf of the government and, in return, are given between 15-percent and 30-percent of the recovered funds. Of the $3 billion recouped by the government in 2017, 92-percent came from cases initiated by whistleblowers.
Despite the program’s success, America’s Department of Justice is now seeking to throttle back the number of FCA cases.
In a recent interview with AARP, Attorney General Sessions said: “Difficulty arises from how hard it is to identify the culprits and a lack of resources for these time-intensive cases.”
Stephen M. Kohn, the Director of the National Whistleblower Center, responded: “The Attorney General’s statement is incomplete. The AG should prioritize the use of existing laws.”
“The Department of Justice will not be able to curb FCA lawsuits and Medicare fraud simultaneously,” said Nicholas Wooldridge, a Las Vegas healthcare fraud attorney. “If the FCA is restrained, Medicare fraud will explode.”
Types Of Medicare Fraud
Medicare fraud is normally seen in several ways, including:
Phantom Billing
The healthcare provider bills Medicare for procedures which either were unnecessary or never performed. Billing for unnecessary equipment is also an example of phantom billing.
Patient Billing
This requires a patient who knows the truth of the scam and gets kickbacks for giving a health care provider their Medicare number. The provider then invoices Medicare, and the patient is instructed to claim they received the invoiced treatment.
Upcoding
The provider inflates bills by utilizing a billing code which shows the patient required expensive procedures when a lesser, or no, procedure was completed.
Largest Case Of Medicare Fraud in America
The Columbia/HCA fraud case in 1996 was the largest case of Medicare fraud in American history. Multiple New York Times articles scrutinized the corporation and its billing practices. The business was raided by Federal agents and the CEO, Rick Scott was dismissed by the health care providers Board of Directors.
While Scott was never personally charged with any crime, HCA ended up pleading guilty to over a dozen charges and paid fines of almost $2 billion.
Omnicare
Health provider Omnicare paid almost $100 million to settle five lawsuits produced under the FCA. The charges involved Omnicare asking for, and receiving, payolas from the pharmaceutical maker, Johnson & Johnson.
Medicare Fraud Strike of 2010
In July 2010 the task force charged 94 people for submitting more than $250 million in fraudulent claims. Physicians, assistants and health care company owners were arrested and faced charges in Baton Route. The false claims covered HIV treatment, physical therapy and other services which were either unnecessary or never provided.
Armenian Gangsters
In October 2010, Armenian gangsters used phantom health clinics to cheat Medicare out of more than $160 million — the largest fraud by one enterprise in the programs history. Armen Kazarian, an Armenian crime boss, protected the operation while over 50 people were arrested in New York, California, Ohio, Georgia and New Mexico.
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