The Justice Department said Wednesday that federal authorities have charged 301 suspects in more than half the states with attempting to defraud Medicare and several other federal insurance programs this year. Healthcare and fraud allegations, among other accusations, have marked the “largest takedown” in the nine-year history of the Medicare Fraud Strike Force.
Last year, 243 people faced charges of fraud that cost the government $712 million, compared to $900 million from this year’s sweep. The department said 60 licensed medical professionals, nurses, pharmacists and physical therapists, have been accused of money laundering, conspiracy to commit health care fraud, and violations of anti-kickback law, among a variety of charges. Those arrested include 60 doctors.
“As this takedown should make clear, health care fraud is not an abstract violation or benign offense. It is a serious crime. The wrongdoers that we pursue in these operations seek to use public funds for private enrichment,” said Attorney General Loretta Lynch, as reported by NBC News.
Officials highlight cases of identity theft, fake prescriptions, and compounding medications
Lynch added that the suspects had targeted people who actually need medical care, falsely promising them effective therapies and cures for their illnesses. But the worst of all, the attorney noted, is their abuse of basic bonds of trust, which have occurred between taxpayer and government, between pharmacist and doctor, and between doctor and patients.
The department has detected new trends in some of the cases, which include identity theft to prepare fake prescriptions. In fact, one doctor told the FBI that someone had used her identity and medical credentials without consent to fill thousands of dollars in prescriptions.
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Other cases reflect instances related to compounding, which consists of mixing medications tailored to meet specific needs. Such drugs are usually very expensive. The quarterly Medicare spending on this kind of prescriptions increased from $28 million in 2012 to $171 million in 2014.
The billings accounted for medical treatments or services such as home care, phony prescriptions and medical equipment that were not medically required or that were not even provided whatsoever.
Authorities say that one case involved five people who were taken into custody in Brooklyn as they were accused of defrauding Medicare in an $86 million scam in which patients received from them kickbacks and then were provided unnecessary occupational and physical therapy, NBC News reported.
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Another case implied two owners of a group of outpatient clinics plus a patient recruiter stand who were accused of filling $36 million in false claims for services and physical therapy that were not part of patients’ actual needs. The method suspects used to find patients involved clinic operators and the recruiter contacting poor drug addicts and offering narcotics to get them the bill for services they never received, as explained by the Justice Department.
The suspects submitted the prescriptions via “telemedicine” sites and doctors received blank prescription forms so they could fill out no matter if they were medically necessary or not.
One federal official involved in the operation said these takedowns are intended not only to warn that theft from taxpayer-funded programs will be punished but also to protect and prevent fraud in programs on which millions of Americans rely, according to NBC News. On Wednesday, Lynch and HHS Secretary Silvia Mathews Burwell discussed the crackdown with other federal officials during a press conference.
Source: NBC News