Medicare Fraud and the Public Images

Loretta Lynch

You go! Attorney General Loretta Lynch’s announcement about Medicare fraud prosecutions isn’t getting the play accorded to more “hot topic” issues, but it’s an important step in doing two things – actually getting fraud out of the Medicare system; and, two dispelling the GOP inference that fraud in social and health care systems is something done by imaginary welfare queens and ne’er do wells.

Who’s getting prosecuted?

U.S. law enforcement officials have charged 301 suspects with trying to defraud Medicare and other federal insurance programs in 2016, marking the “largest takedown” involving health care fraud allegations, the Justice Department said on Wednesday.

The national sweep resulted in charges against doctors, nurses, pharmacists and physical therapists accused of fraud that cost the government $900 million, the department said. The cases involved an array of charges, including conspiracy to commit health care fraud, money laundering and violations of an anti-kickback law. [NatMemo] (emphasis added)

That gives us a general idea that no, the fraudsters weren’t those so often maligned by conservatives as the “undeserving” poor who take advantage of “sacred tax dollars.”  These are professionals, presumably unwilling to settle for professional earnings, income derived professionally.  We can get a bit more specific.

“One group of defendants controlled a network of clinics in Brooklyn that they filled with patients through bribes and kickbacks.  These patients then received medically unnecessary treatment, for which the clinic received over $38 million from Medicare and Medicaid – money that the conspirators subsequently laundered through more than 15 shell companies.” [Lynch DoJ]

How many “undeserving poor” launder money through 15+ shell corporations?

Detroit clinic billed Medicare for more than $36 million, even though it was actually a front for a narcotics diversion scheme.” [Lynch DoJ]

“…another defendant took advantage of his position in a state agency in Georgia by accepting bribes and recommending the approval of unqualified health providers.” [Lynch DoJ]

Lovely.  Another Department of Justice public statement offers a few more details.

“According to court documents, the defendants participated in alleged schemes to submit claims to Medicare and Medicaid for treatments that were medically unnecessary and often never provided.  In many cases, patient recruiters, Medicare beneficiaries and other co-conspirators allegedly were paid cash kickbacks in return for supplying beneficiary information to providers, so that the providers could then submit fraudulent bills to Medicare for services that were medically unnecessary or never performed.  Collectively, the doctors, nurses, licensed medical professionals, health care company owners and others charged are accused of conspiring to submit a total of approximately $712 million in fraudulent billing.”  [HCFU DoJ]

What’s been the nature of the Congressional interest in the Health Care Fraud Unit’s efforts?  In 2013 it was to cut funding for Medicare and Medicaid fraud prosecution efforts. [CNBC] [WaPo] We might also want to remember that any additional mandatory funding beyond 2013 levels did not start  until 2015. [HHS]

The notion that “waste, fraud, and abuse” are associated with government employees and the undeserving – is directly challenged by the efforts of the Departments of Health and Human Services and the Department of Justice, and their findings that the fraudsters are among the professional civilian population – ready and willing to line their own pockets with tax dollars.

But don’t necessarily trust me, listen to the Inspector General:

“Health care fraud drives up health care costs, wastes taxpayer money, undermines the Medicare and Medicaid programs, and endangers program beneficiaries,” said Inspector General Levinson.  “Today’s takedown includes perpetrators of prescription drug fraud, home health care fraud, and personal care services fraud, three particularly harmful types of fraud plaguing our health care system.  This record-setting takedown sends a message to would-be perpetrators that health care fraud is a risky way to line your pockets.  Our agents and our law enforcement partners stand ready to protect these vital programs and ensure that those who would steal from federal health care programs ultimately pay for their crimes.” [DoJ]

Health care fraud investigators and prosecutors should be among the nation’s heroes, not castigated as ‘gum’int bureaucrats,’ and should have budget and resource support commensurate with the importance of what they are trying to accomplish.

2 Comments

Filed under Medicaid, Medicare

2 responses to “Medicare Fraud and the Public Images

  1. Reblogged this on Grab and Keel and commented:
    Medicare fraud? Not from “welfare queens”, but the medical community!

  2. thank you for the reblog DB