$452 Million Lost To Medicare Fraud

Earlier this week, the U.S. Department of Justice announced the fourth nationwide sweep in the last two years for alleged illegal practices by Medicare providers (doctors, nurses, and social workers) that resulted in criminal charges against 107 Medicare providers who allegedly stole $452 million from Medicare. Those arrested were located in seven major U.S. cities: Los Angeles, California; Tampa, Florida; Miami, Florida; Baton Rouge, Louisiana;  Houston, Texas; Detroit, Michigan; and, Chicago, Illinois. On May 2, 2012, 87 arrests were made.

In addition to the 107 who were part of the Medicare nationwide sweep, 52 medical providers were subjected to suspensions or other administrative actions by the U.S. Department of Health and Human Services regarding allegations of fraudulent billing practices.

The alleged fraudulent billing practices involving Medicare patients (there are about 50 million people in the U.S. who have Medicare health care coverage) include allegations that two doctors (eight people total) in the Greater Los Angeles area billed Medicare approximately $20 million for services that were never provided.

The illegal schemes included medical equipment providers billing Medicare for medical equipment that was never provided to Medicare patients, and Medicare providers paying kickbacks to schemers who recruited Medicare beneficiaries who did not need or use medical equipment so that doctors in on the scam could write prescriptions for them for medical equipment that were billed to Medicare.

Medicare fraud is rampant and continues to rise: the federal government revoked the eligibility of more than 60,000 Medicare and Medicaid providers and suppliers in 2011, and recovered $4.1 billion in fraudulent claims. In 2011, 1,430 people were charged by the federal government with health care fraud, which was a sizable increase from the 797 people who were charged with similar crimes in 2008.

Medicare and Medicaid fraud result in losses between $20 billion and $100 billion each year. It is anticipated that in 2012, the total Medicare and Medicaid expenditures will reach $1 trillion.

While the U.S. government now employs new computer methods for cracking down on fraudulent Medicare and Medicaid billings and payments, unscrupulous Medicare and Medicaid providers continue to seek new and innovative methods of cheating U.S. taxpayers. However, this latest round of nationwide Medicare fraud enforcement actions should be a stark warning and wake-up call to those who seek to obtain money for services and medical equipment not necessary or not provided that they will leave a trail that will ultimately result in their downfall. Recent criminal sentences for those convicted of Medicare fraud have reached up to 50 years in federal prison.


As medical care resources become more scarce and more expensive, the effects of Medicare and Medicaid fraud on ordinary citizens become more pronounced and more serious. If a Medicare or Medicaid recipient cannot obtain necessary medical care or necessary medical equipment because criminals have bilked the government out of limited financial resources, then the victims of Medicare and Medicaid fraud are not just the Medicare and Medicaid beneficiaries, but also their families and their communities.

If you have knowledge of possible Medicare fraud or Medicaid fraud, you may become a “whistle blower” and thereby be entitled to receive a share of the amount that the government may collect as a result of your efforts in bringing the information regarding possible fraud to the attention of the appropriate authorities. Medical malpractice attorneys may be able to assist you in your efforts.

Click here to visit our website to be connected with medical malpractice lawyers in your state who may be able to assist you with a whistle-blower claim regarding Medicare fraud or Medicaid fraud, or telephone us toll free at 800-295-3959.

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This entry was posted on Sunday, May 6th, 2012 at 10:23 am. Both comments and pings are currently closed.


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