Since its inception a decade ago, the Medicare Fraud Strike Force has charged more than 3,500 people with ‘ripping off’ Medicare as of early 2017. These are nine teams (made up of agents, investigators, prosecutors, auditors, etc) based in fraud hot spots such as Miami, Los Angeles, Detroit, Southern Texas, New York City, Southern Louisiana, Chicago and Tampa.
Here are some examples of the type of cases that the Medicare Fraud Strike Force goes after:
1.) Using Fake Patients for Payment.
Miami based agents investigating Medicare Fraud heard of suspicious practices of a psychiatric medical facilities recruiting patients, and so they started investigating. Here is what they found: medical facilities were paying recruiters to scare patients. Many of those people were drug addicts who were not in need of psychiatric services, but were looking for case or substance-abuse treatment. They were coached to say that they were suicidal to generate bogus Medicare claims. The CEO of the facility was convicted and sentenced to serious jail time.
2.) False Billing by Healthcare Providers.
These health care companies were billing Medicare for bogus home health services. The task force carefully checked patient records and compared them for billing records and found instances where patients were not care for, but the health care providers were billing anyways. Some patients were given expensive treatments that they did not need, and Medicare was even billed for services that did not happen at all.
3.) The Opioid Medicare Connection.
Medicare numbers are worth more on the black market than credit card numbers, since Medicare numbers can be used to bogus opioid prescriptions. The pills are then sold on the street for big profit. Monitoring opioid prescriptions is difficult because they are so frequently given to patients in pain. One in three Medicare Part D beneficiaries received at least one opioid prescription in 2016. One case in Detroit involved a doctor who used recruiters to find patients whose Medicare numbers he could steal. He would then use those numbers to give patients painkillers for cash. This particular doctor was sentenced to 23 years in prison.