Anyone who is, or has a parent who is, covered by medicare knows that healthcare fraud is a tangible risk. Some good news, then, on this Monday, is that Attorney General Eric Holder and HHS Secretary Kathleen Sebelius announced last Friday at a healthcare fraud summit in Miami, that the feds are in the process of the largest fraud takedown ever, with 94 defendants charged in five different cities (Baton Rouge, LA, Detroit, MI, Houston, TX, Miami FL, and New York, NY)
Also in conjunction with the Miami summit, which gathered together insurance providers, consumer advocates, and patients as well as federal, state, and local authorities, came the announcement from HHS that the state of Florida has been granted a Medicaid waiver which will help fund a program allowing the state’s Medicaid Fraid Control Unit to scan insurance claims for patterns that are red flags for insurance scams. Currently, Federal law prohibits federal matching funds from being used in such fraud control efforts.
As of Friday morning, 36 alleged participants had been arrested in connections with schemes involving over $250 million in fraudulent claims, according to the Justice Department. The suspects include insurance company owners, medical assistants, and doctors, and the allegations against them fit the profile of the kind of healthcare fraud typical of South Florida over the last several years – fraud that is now spreading across the country, with scammers filing false claims for HIV infusion services, home healthcare, durable medical equipment, and physical therapy, and beneficiaries getting monetary kickbacks for their Medicare numbers.
There are plans for additional, similar healthcare fraud summits to be held in Boston, Detroit, Las Vegas, Los Angeles, New York, and Philadelphia.