The following editorial appeared in the St. Louis Post-Dispatch:
News coverage of last week’s simultaneous arrests of 107 people in seven cities for alleged health-care fraud pretty much appeared and disappeared in a day, at least outside Miami, Baton Rouge, Houston, Los Angeles, Detroit, Tampa and Chicago, the cities involved.
Behind the headlines, however, is a little-noticed law enforcement program that has focused exclusively on health-care fraud, waste and abuse for 15 years.
Given the fashionable reflex to blame government for everything, it’s worth taking special note of a joint federal, state and local collaboration that so far has recovered and returned more than $20 billion of taxpayer money to the Medicare Trust Funds, and additional funds to other health care programs.
The indictments underpinning last week’s operation by multiple federal, state and local agencies allege some $450 million in false Medicare billings, more than any other single enforcement action to date.
In addition to handling the arrests, more than 500 agents of a special Medicare Fraud Strike Force also suspended the Medicare participation rights of 52 health care providers and executed an additional 20 search warrants connected with other ongoing investigations.
The strike force, which is jointly supervised by the U.S. Departments of Justice and Health & Human Services, operates through the authority of the Health Care Fraud and Abuse Control Program originally created by Congress in the Health Insurance Portability and Accountability Act of 1996.
According to a description released by HHS, the charges against those arrested in last week’s seven-city operation were based on “a variety of alleged fraud schemes involving various medical treatments and services such as home health care, mental health services, psychotherapy, physical and occupational therapy, durable medical equipment and ambulance services.”
There were bills submitted for medical services that weren’t needed and bills for services that were never provided, as well as kickbacks paid for Medicare beneficiary information used in submitting the bills.
Those arrested deserve fair trials and, if convicted, license revocations and prison time.
Contrary to the tired racial and class stereotypes of high-living welfare queens and other supposed cheats, health care fraud strike force investigators — working in the real world — find large-scale fraud where the large-scale money is: on the provider side, not the consumer side.
Last week’s indictments and supporting court documents named owners of health care companies and ambulance companies, doctors, nurses, licensed social workers, physical and psychological therapists and a pharmacist.
The annual report on the Health Care Fraud and Abuse Control Program, released in February, charted some $4.1 billion collected through criminal and civil enforcement actions and deposited in the Medicare Trust Funds and the U.S. Treasury and transferred to other federal agencies involved in health care programs.
Not included are funds returned to states for fraud involving Medicaid.
At 17 percent of America’s gross domestic product, health care is as big and complex a business as there is, and most of its constituent parts operate honestly. But there’s so much money in play that would-be criminals seem endlessly creative and resourceful.
Estimates of the annual cost of health care fraud range from $60 billion to $90 billion.
The enforcement work of the Health Care Fraud and Abuse Control Program has returned an average of $5.10 for every $1 spent since 1997, and the ratio has increased in recent years.
Those are rich dividends.




Comments (3)
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You guys should stop complaining because, one the health care we have now isnt as good as it was supposed to be. also the law has just been signed so give it some time. so if u want to say u have the right to choose tell that to ur congress men or state official. If you do not have insurance and need one You can find full medical coverage at the lowest price search online for "Penny Health" If you have health insurance and do not care about cost just be happy about it and trust me you are not going to loose anything!
Fraud can be subtle too
Billing fraud doesn’t have to be blatant and gigantic like the fraud mentioned in the piece nor does it have to involve medicare/medicaid in order to harm the public.
Fraud is a major influence in the cost of our healthcare and deserves as much attention and blame as chronic conditions.
Tacking on a few extra procedures or pumping up care to the next break point is pretty easy when the person receiving the services never really sees the bill or understands the process.
Remember when our medical insurance companies regularly asked us to review our bills and report anything unusual or services we didn’t receive? Wonder why we aren't asked anymore? Is it possible the insurance industry wants us to be so afraid of medical costs that we are putty in their hands?
We need to really crack down on fraud, hold our providers accountable for what they charge, and reign in price gouging by Big Pharma.
The government should play a bigger role in protecting the public from greedy crooked providers and force Big Pharma to treat Americans at least as well as they treat their foreign customers.
Alaska clinics and the Indian Health Service won't change
until the frauds units come knocking. I hope it's soon!