KHN Morning Briefing

Summaries of health policy coverage from major news organizations

94 Indicted In Five-State Crackdown On Medicare Fraud

Law enforcement officers fanned out across five states Friday in what federal officials called the largest Medicare fraud bust ever conducted. Nearly 100 people were indicted in frauds that totaled $251 million.

The Associated Press: "Several doctors and nurses were among those arrested in Miami, New York City, Detroit, Houston and Baton Rouge, La., accused of billing Medicare for unnecessary equipment, physical therapy and HIV treatments that patients typically never received. Ninety-four suspects were indicted, and authorities said 36 people had been arrested as of Friday morning. ... 'With today's arrests we're putting would-be criminals on notice: health care fraud is no longer a safe bet,' [Attorney General Eric] Holder said Friday. ... [T]he schemes involve a sophisticated network of doctors, clinic owners, patients and patient recruiters. Violent criminals and mobsters are also tapping into the scams, seeing Medicare fraud as more lucrative than dealing drugs and having less severe criminal penalties, officials said" (Kennedy, 7/16).

The Washington Post: "The arrests came as Attorney General Eric H. Holder Jr. and Health and Human Services Secretary Kathleen Sebelius held the first in a series of regional 'summits' on health-care fraud prevention in Miami. The high-level attention marked the latest step in crackdown on fraud that the Obama administration has said is a key part of its agenda on health-care reform. ... The cost of Medicare, which covers the elderly and disabled, and Medicaid, its sister program for the poor, are growing as the American population ages, giving new urgency to initiatives to detect and prevent phony claims. Health-care fraud is believed to rob the nation's coffers of billions of dollars each year. In May 2009, the administration launched a high-level task force, the Health Care Fraud Prevention and Enforcement Action Team, which uses electronic claims data -- and the threat of federal prosecution -- to seek out illicit billing" (Markon, 7/16).

CNN: "Charges include filing fraudulent claims for HIV/infusion services, home health care, physical therapy and durable medical equipment. The Medicare Fraud Strike Force is a joint effort by the Department of Justice and the Department of Health and Human Services. The team works with federal, state and local investigators to analyze Medicare data and emphasizes community policing" (Chernoff and Steffen, 7/16)

The Wall Street Journal: "In Brooklyn, the government charged, among others, doctors Gustave Drivas and Jonathan Wahl and their partners. ...  The medical clinics run ... paid Medicare patients cash to entice the patients to get extra unnecessary treatment so that Medicare would be billed more, prosecutors said. The patients were paid in what the government referred to as 'the Kickback room,' a room marked private that only featured for decoration a poster with a woman holding her finger to her lips and, written in Russian, the words 'Don't Gossip.' ... In all, the government said Mr. Drivas's group billed Medicare for nearly $72 million and received $46.9 million in reimbursements. The eight have been each been charged in a criminal complaint with one count of conspiracy to commit health care fraud. Four other criminal complaints by the U.S. Attorney's Office in Brooklyn were filed against a total of 14 other defendants involving four separate schemes" (Benoit, 7/16).

The Miami Herald: "About 25 suspects, including longtime general practitioner Dr. Jorge J. Dieppa, were charged in Miami-Dade County for allegedly submitting about $103 million in fraudulent bills for home healthcare, HIV therapy and medical equipment services, according to federal indictments. ... Dieppa, 56, whose practice is in Miami's Flagami neighborhood, is accused of receiving kickbacks for making hundreds of patient referrals to home healthcare agencies for costly diabetic services that were unnecessary" (Weaver, 7/16).

Detroit Free Press: "'We want to make sure that providers out there know we are looking at you,' Assistant U.S. Attorney Barbara McQuade said at a news conference in Detroit. 'If you are making false billings, you will be brought to justice.' ... Those arrested in the metro Detroit cases were responsible for $35 million in Medicare fraud, authorities said. ... McQuade and Detroit FBI chief Andrew Arena said economically distressed areas like metro Detroit are hot spots for Medicare fraud, which prompted McQuade to assign more people to prosecute such cases" (Ashenfelter, 7/16).

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