As part of the Centers for Medicare and Medicaid Services’ (CMS) continued efforts to combat Medicare fraud, federal charges were recently brought against 90 individuals across the nation for false billings to Medicare, totaling $260 million dollars. These charges were the result of a collective task force comprising federal, state, and local agencies and the use of data analysis and increased community awareness. This takedown marks the seventh national takedown conducted by the federal Medicare Fraud Strike Force. The goal of the Medicare Fraud Strike Force is to protect taxpayer resources and senior citizen rights by combating fraud and abuse in the Medicare system for personal gain. The 90 individuals charged in this takedown were out of Miami, Houston, Los Angeles, Detroit, Tampa and Brooklyn, and 27 of them are medical professionals.
Our Atlanta and Augusta, Georgia health care law firm represents health care providers and businesses. In this matter, the charges are based on the accusation that the defendants conspired to commit health care fraud, money laundering and violations of the federal anti-kickback statute. The defendants allegedly submitted claims to Medicare for medically unnecessary or nonexistent treatment and services. In addition, the defendants are accused of paying cash kickbacks to patient recruiters and Medicare beneficiaries in exchange for patients’ Medicare beneficiary numbers, which were then used to fraudulently bill Medicare for services or equipment that were not needed and/or never provided. According to the government, this level of fraud is the ultimate betrayal of trust for a patient. If convicted, these medical professionals show they were willing to steal their patient’s information, essentially their medical identities, and then seek their own personal gain over their patients’ wellbeing by ordering procedures and equipment that they never needed.
Blatant acts of fraud, such as what appears to be involved in this particular case, are easy to recognize and condemn. What many health care providers do not realize, however, is how easy it is for them to violate broadly-worded federal regulations, such as the anti-kickback statute, with particular business arrangements. The federal Medicare program contains very complicated regulations and specific rules, such that any health care provider could unintentionally violate them. With such high stakes for their finances and their professional reputation, medical professionals are well advised to be vigilant and focused on fraud avoidance and good compliance practices, so as not to attract the government’s attention.
Georgia Health Care and Business Law Firm
If we can provide any additional information regarding this post or other health care law issues, contact us at (706) 722-7886 (Augusta) or (404) 685-1662 (Atlanta) to schedule a confidential consultation.
US DOJ Press Release of $260 million Billing Fraud Charges
*Disclaimer: Thoughts shared here do not constitute legal advice.