Where to begin with this National Fraud Takedown that made my eyes blur. The investigation yielded 243 indictments of doctors, nurses, and other licensed medical professionals in several states. Who cares? We all should. If you aren’t old enough to worry about Medicare now, that day will come. The schemers collectively netted about $712 million of our tax dollars in false billings.
Fraud cases make me angry, but I lose interest when reading about them because the content is complex and, to be honest, boring.
Are fraud case indictments page-turning reads? No.
Are the frequency and cost of fraud cases shocking? Yes.
Is Medicare fraud happening nationwide? Yes.
I’ll summarize what took place with one group of schemers—four men that grew to include the co-conspirators. Collectively, they fraudulently billed Medicare for $7.8 million in services never performed.
They set up chiropractic clinics, recruited unsuspecting chiropractors, managed the clinics, and handled the billing. Then they paid people to seek chiropractic services and to stage vehicle accidents with injuries which led to rehab treatments.
As the accounting service for the chiropractic clinics, they had access to the chiropractor’s provider numbers (needed to establish the clinics) which also gave them full access to patients’ medical records. As you can guess, some identity theft occurred as well. When they billed Medicare, they claimed services never provided.
A Medicare Fraud Strike Force Team (program established in 2007) identified this fraudulent clinic operation and brought the culprits to justice. Judges sentenced the defendants to anywhere from probation to six years in prison with large restitutions payments.
A U.S. Attorney associated with strike force cases said,
“Losses caused by health care fraud are staggering, sadly, the losses are passed along to the rest of us in the form of increased health care costs.”
An Attorney General associated with the overall takedown said,
“This action represents the largest criminal health care fraud takedown in the history of the Department of Justice, and it adds to an already remarkable record of enforcement.”
If you google ‘Medicare Fraud,’ it’s shocking how many cases are being processed. The U.S. Medicare Fraud Strike Force operates nation-wide and is working hard to bring fraudsters to justice.
A word of caution to any businessperson who uses a third-party accounting service—have another accounting firm not affiliated with the one being used, perform an annual audit of the books.
Source: U.S. District Court, U.S. Department of Justice, courier journal,