Nationwide Medicare fraud crackdown underway

Federal authorities are making Medicare fraud enforcement a high priority.

Combating Medicare fraud is a clear priority of the Department of Justice and legislators across the U.S.

For example, recent enforcement actions by multiple government agencies resulted in the arrest of 90 people across the U.S. for Medicare fraud that totaled $260 million, according to the Department of Justice. The arrests netted 90 individuals in six cities, including 27 doctors, nurses and medical professionals. The same week as the arrests, lawmakers finalized proposed legislation attempting to increase enforcement of Medicare fraud.

According to the authors of the new legislation, which has bipartisan support, Medicare is susceptible to fraud because of "the future adoption of new code sets; new provider enrollment procedures; limited resources; and the ever-increasing sophistication of Medicare fraud schemes." Some estimates put the cost of Medicare fraud from $60 to $90 billion annually in the U.S.

According to the proponents of the bill, the Stop SCAMS Act of 2014 would:

  • Allow private insurers to share information with Medicare to reduce fraud
  • Require verification that potential Medicare enrollees did not have ownership in a company that defrauded Medicare in the past
  • Better target fraud by having the Medicare Payment Advisory Commission make recommendations on fraud prevention efforts
  • Test Medical codes before the HHS could implement a new coding system to ensure that payments are not delayed and all fraud prevention policies are in place.

As it stands, the legislation has support from a wide array of insurance and anti-fraud groups, including the National Health Care Anti-Fraud Association, the National Insurance Crime Bureau, Humana and the Blue Cross Blue Shield Association.

The Senate Special Aging Committee has also recently launched a new anti-fraud toll-free hotline to help people report suspected fraud.

A Medicare fraud defense attorney can help

It is not surprising that federal authorities are putting a priority on Medicare fraud prevention. With billions of taxpayer money apparently at stake, public interest in Medicare fraud is at an all-time high.

In 2012, the most recent year data is available, the Justice Department began over 1,000 new criminal healthcare fraud investigations, involving over 2,000 potential defendants. That same year over 800 people were convicted of Medicare fraud. Federal anti-fraud enforcement actions in 2013 and 2014 have if anything increased from previous efforts.

Despite the public furor, however, only a relatively small number of medical professionals are convicted of Medicare fraud. And Medicare plays a valuable role in providing care to vulnerable populations.

Medical professionals accused of Medicare fraud have a lot to lose. Potential penalties include significant fines, restitution and prison time. If you are currently under investigation or have been accused of Medicare fraud, contact an experienced criminal defense attorney familiar with handling Medicare fraud defense cases to protect your rights and ensure you mount a vigorous defense.

Keywords: Medicare, fraud, federal investigations