Medicare Fraud Strike Force teams, made up of FBI, Department of Health & Human Services and Department of Justice officials, along with local police, uncovered Medicare fraud schemes totaling $712 million in June. Law enforcement arrested and charged over 240 doctors, nurses and other licensed healthcare professionals for allegedly participating in the scheme in 17 cities around the United States. More than half of the alleged fraud involves home health care companies.
These strike force teams have been in place since 2007, repeatedly breaking up fraud rings. In fact, over 2,300 people have been charged with falsely billing Medicare to the tune of more than $7 billion!
The people recently arrested were involved in a variety of schemes. Some were billing for treatment that was medically unnecessary. Others billed Medicare for care they never even provided. Cash kickbacks are also rampant; many healthcare workers are in the process of being indicted for trading referrals for cash and for supplying patient information so doctors could submit fraudulent bills to Medicare.
When it comes to home health care agency fraud, some say it’s easy to spot fraud, others contend that the agencies shouldn’t be liable for “inadvertent fraud.” (This might be when a doctor prescribes an unnecessary treatment and the home health company provides the service. They were following doctor’s orders.) However, in most cases, fraud exists when the home health aide agency bills for services they didn’t provide or that a reasonable healthcare agency would know is unnecessary.
Medicare prohibits kickbacks – paying healthcare “recruiters” to attract Medicare patients. Officials say many home health care agencies currently under scrutiny were paying kickbacks in return for referrals.
Under the Affordable Care Act, new screening techniques are in place to prevent providers from being approved to participate in the Medicare system. Additionally, new computer systems are designed to recognize and stop fraudulent billing practices.
Federal scrutiny of home health agencies is not likely to end anytime soon, as government agencies plan to continue their fight to eliminate healthcare fraud. “We will not stop here,” said HHS Secretary Sylvia Mathews Burwell. “We will work tirelessly to prevent these programs from becoming targets and fight fraud wherever we find it.”
For people who work in medical facilities, experts say there are some things to look for if you suspect fraud. If doctors are signing prescription pads and allowing others to fill in patient and medication information, this is a red flag. Another indication of possible fraud is if a doctor is prescribing controlled dangerous substances for conditions that do not require those medications. Also, if a doctor is prescribing controlled substances to many of the practice’s patients, this could be considered fraudulent behavior.
Contact a skilled whistleblower attorney with your concerns and suspicions relating to healthcare fraud. At Begelman & Orlow, we will help determine if you have a case and we will be by your side every step of the way.
5. A doctor prescribing a drug that is also a controlled substance to a very large majority of their patients. This could be a violation of government fraud and a potential false claims case to take action on.