U.S. Cracked Down On A Record Number Of Medicare Fraudsters In 2013

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A special task force that targets doctors, providers, and individuals who defraud Medicare had a record year of prosecutions in 2013, according to the Department of Justice.

Since its inception in 2007, the so-called Medicare Fraud Strike Force has prosecuted 1,700 defendants who bilked the public entitlement for seniors of more than $5.5 billion. Medicare fraud usually comes in the form of unscrupulous doctors and medical providers who take advantage of sick seniors and over-bill them for their treatments.

In 2012, the strike force pulled off one of the biggest fraud busts in American history, arresting 91 people across seven cities for perpetrating $230 million in home care billing fraud and $100 million in mental health care billing fraud.

According to new figures released on Monday, the agency continued that trend in 2013, filing 137 cases against 345 individuals. That ultimately led to 234 guilty pleas and 46 jury convictions.

“The Medicare Fraud Strike Force is one of this country’s most productive investments,” said Acting Assistant Attorney General Mythili Raman of the DOJ’s Criminal Division in a statement. “We are not only putting hundreds of criminals who steal from Medicare in prison, but also stopping their theft in its tracks, recovering millions of dollars for taxpayers, and deterring potential criminals who ultimately decide the crime isn’t worth it.”

A 2013 report by the Department of Health and Human Services Inspector General found that the federal government receives and eight-fold return on every dollar spent by the strike force, lending credence to Raman’s claims about deterrence.

The 2009 stimulus bill and the Affordable Care Act are both likely contributors to the uptick in Medicare fraud busts. For instance, Obamacare allows HHS and the DOJ to coordinate their efforts and encourages new fraud analysis methods that can identify suspicious medical claims, typically in regions with a history of abuse such as Houston, Texas and Tampa, Florida.