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Medicare Insurance Fraud Scandals on the Rise in 2015

January 4, 2016 // News

scandal1This summer, the largest Medicare fraud bust involved the arrest of 243 people, including 43 doctors and nurses over $712 million worth of illegal billing and bogus patient care. In Miami, a mental health facility billed over $64 million dollars for psychotherapy treatment sessions that never happened; in fact, patients were simply moved to different locations. A California doctor was charged with ordering power wheelchairs for people who didn’t need them, and inflating home health care billings for services never provided.

In Michigan, a doctor illegally prescribed narcotics to patients in exchange for their personal medical information. Once addicted, the doctor would continue to provide the drugs while he used the patient’s information to fraudulently bill for services never provided.

In December, two nurses and a medical director of a home health care agency were arrested for recruiting healthy Medicare beneficiaries for unnecessary home visits. The medical director never examined the majority of the patients, despite a Medicare requirement that a doctor certify the need for home care via a face-to-face visit. The scam totaled over $27 million in false claims.

In a swindle being dubbed ‘Operation Spinal Cap’ by prosecutors, two California orthopedic surgeons, along with the former CFO of a hospital were charged with fraudulently billing $600 million dollars’ worth of illegally referred spinal surgeries. The kickback scheme involved doctors and chiropractors who were paid to refer patients to Pacific Hospital in Long Beach even though there were closer facilities available for the patients. The CEO, also indicted, and his associates would then illegally bill for the procedures through workers compensation.

Since 2007, over 2300 people have bilked Medicare and Medicaid for more than $7 billion dollars, according to the Department of Justice Medicare Fraud Strike Force, who led the investigations.

Medical identity theft is also on the rise and is included in many Medicare and Medicaid scams. The FBI warns that people they call “patient recruiters” often attempt to gain access to personal medical information by hanging around soup kitchens or homeless shelters offering this often vulnerable population money in exchange for their Medicare identification numbers. The personal medical information is then used to submit fraudulent claims or for resale on the black market.

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