U.S. Arrests 91 In Massive $430 Million Medicare Fraud Bust

Health and Human Services (HHS) Secretary Kathleen Sebelius and Attorney General Eric Holder announced Thursday that the Medicare Fraud Strike Force has arrested 91 people for a variety of Medicare billing fraud schemes across seven U.S. cities. The alleged fraud is massive in both scope and breadth, totaling over $230 million in home care billing fraud and $100 million in mental health billing fraud and involving health professionals including doctors, nurses, and various other care providers:

“Today’s enforcement actions reveal an alarming and unacceptable trend of individuals attempting to exploit federal health care programs to steal billions in taxpayer dollars for personal gain,” said Attorney General Holder. “Such activities not only siphon precious taxpayer resources, drive up health care costs, and jeopardize the strength of the Medicare program — they also disproportionately victimize the most vulnerable members of society, including elderly, disabled and impoverished Americans.”

“Today’s arrests put criminals on notice that we are cracking down hard on people who want to steal from Medicare,” said HHS Secretary Sebelius. “The health care law gives us new tools to better fight fraud and make Medicare stronger. In addition to the arrests made today, HHS used new authority from the health care law to stop future payments to many of the health care providers suspected of fraud, saving Medicare resources and taxpayer dollars from being lost to fraud in the first place.”

The Obama Administration has taken Medicare billing fraud very seriously, setting up consumer-driven watchdog groups, issuing strict warnings to providers about gaming Medicare for personal gain, and enforcing strong fraud-prevention measures in Obamacare, all in an effort to curb unsavory (and illegal) practices such as “upcoding” that have the potential to devastate the medically needy by looting the safety-net program’s funds and driving up costs. The recent arrests go to show that the Administration has the bite to go with its bark.

“This is the result of coordinated anti-fraud efforts – including Medicare flagging suspicious activity, efforts between agencies to investigate this criminal activity, and today’s actions by law enforcement and HHS,” said CMS Deputy Administrator for Program Integrity Peter Budetti. “As we stop payments to these providers suspected of fraud, we continue our efforts to move from a pay-and-chase model to one where we stop fraudsters before they can successfully bill Medicare and Medicaid.”