Medicare is riddled with fraud that costs the government an estimated $60 to $90 billion a year. Ramping up Medicare oversight, the Department of Justice coordinated a bust yesterday spanning nine cities. One hundred and eleven doctors, nurses and physical therapists were arrested, reports the Associated Press, accused of earning a combined $225 million in Medicare fraud schemes.
The busts, which took place largely in Los Angeles, Brooklyn, Detroit and Miami, included more than 40 schemes.
Some providers engaged in more simple Medicare fraud tactics--charging for procedures that were never conducted, overbilling, writing fake prescriptions, and billing for treatment that was not medical in nature, according to the Associated Press. Others were a bit more inventive.
The largest of the Medicare fraud schemes billed Medicare nearly $57 million in the last two years, details The Wall Street Journal. A group of physical therapy clinics in Brooklyn, which, according to the AP, were run by a network of Russian immigrants, paid recruiters to find elderly patients. The ring also involved two medical-transport companies. Perhaps they were the recruiters?
Medicare fraud is illegal under a variety of statutes. The False Claims Act and the False Statements Act impose fines and imprisonment of up to five years on healthcare providers who make false or fraudulent statements to the government. The Social Security Act also considers false statements in connection with federal healthcare programs to be a felony.
Those who engage in Medicare fraud are also subject to state laws, ordinary fraud laws, and civil penalties. Patients who help perpetrate these schemes can also be held liable.