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Government launches largest Medicare fraud raid in history

May 09, 2012
Uncategorized By LW Consulting Inc.

The government's most substantial intervention into improper Medicare billing practices has caused 107 medical professionals in seven different cities to be charged with fraud, while 87 have already been arrested. The collective crimes of these individuals led to $452 million in fraudulent claims.

According to a report, 17 healthcare professionals in Houston and Los Angeles alone were charged with Medicare fraud last week. The individuals worked for a variety of different healthcare companies, including a home care company, a medical equipment provider and an ambulance operator.

"Medicare is an attractive target for criminals," assistant attorney general Lanny Breuer told the The Los Angeles Times on May 2. "If you don't believe it, ask Lawrence Duran, the former owner of a mental healthcare company in Miami, who was sentenced last year to 50 years in prison."

Since the Obama administration's landmark healthcare reform became law in 2009, HHS has made a concerted effort to curtail fraudulent Medicare and Medicaid billing practices, which cost the government $70 billion annually, according to the Centers for Medicare and Medicaid Services (CMS). Last week's crackdown is the fourth in the last two year.

With that law came an electronic system that is better able to track possible instances of fraud, which allow government auditors to go back and investigate bills that are earmarked as being suspicious. In the last year, the number of healthcare professionals charged with fraud doubled based on the figures released just before the Affordable Care Act became law.

Fraud is rampant with these two government programs as some healthcare providers believe they can slip improper reimbursements through without getting caught. CMS readily acknowledges the problem and in 2011, the Government Accountability Office (GAO) made recommendations to CMS on how it can best reduce fraudulent claims.

To avoid these types of clerical errors, and the penalties that could accompany them, healthcare providers should work with a medical billing consultant with knowledge of proper reimbursement procedures.