Medical News: Operation Targets $225M in Healthcare Fraud - in Public Health & Policy, Medicare from MedPage Today

By Joyce Frieden, News Editor, MedPage Today Published: February 18, 2011

WASHINGTON -- The largest healthcare fraud operation in U.S. history has nabbed suspects accused of collectively defrauding Medicare of more than $225 million, according to officials from the Department of Health and Human Services (HHS) and the Department of Justice (DOJ).

The Medicare Fraud Strike Force charged 111 defendants in nine cities for their alleged participation in Medicare fraud schemes, officials announced on Thursday. Defendants included doctors, nurses, and healthcare company owners and executives, among others.

"With this takedown, we have identified and shut down large-scale fraud schemes operating throughout the country. We have safeguarded precious taxpayer dollars. And we have helped to protect our nation's most essential healthcare programs, Medicare and Medicaid," said Attorney General Eric Holder in a statement. "As [these] arrests prove, we are waging an aggressive fight against healthcare fraud."

More than 700 law enforcement agents from the FBI, the HHS Office of Inspector General, multiple Medicaid Fraud Control Units, and other state and local law enforcement agencies participated in the operation.

via medpagetoday.com

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Doctors who order tests for their own financial gain-KevinMD.com

Doctors who order tests for their own financial gain

6 comments

in Physician practice

by Kohar Jones, MD

“What a shame,” said my eighty eight year old Armenian grandmother, shaking her head with sorrow, and I had to agree. “US officials charge 73 people, mostly Armenians, over a massive fraud against the country’s medical insurance system,” read the BBC headline.

A (mostly) Armenian crime syndicate set up 115 sham clinics in the United States, using real doctors’ names and real patient information, stolen from different systems, to generate false Medicare claims.

Dermatologists examined hearts.  ENT doctors performed pregnancy ultrasounds. (And Medicare beneficiaries, it must be noted, are usually past child-bearing age.)

At some point, $35 million later, someone noticed the discrepancies. How broken is our health care payment system that an interstate, international mafia could steal $35 million from US taxpayers via false Medicare claims? How broken is our health care payment systems than an upstart Armenian mafia would even decide that Medicare should become the new black market, filled with low-hanging fruitful ways to make an easy buck? Whatever gave them the idea?

Perhaps they learned from low-level not-quite-gangsters racketeering their way to easy profits—the real doctors in real storefront clinics seeing real patients, for example, who happen to have high blood pressure– performing EKGs every three months for no good medical reason. Should we call it a scam when real doctors refer real patients to the imaging sites down the road in which the doctors have partial ownership, to perform imaging studies for no strong medical indication? How might this contribute to a “massive fraud” of medical overutilization?

The Armenian Medicare Mafia brings shame to my ethnicity. Doctors who order for their own financial gain, I believe, bring shame to my profession.

Three cheers for shame-free doctoring! Let us give patients what patients need, no less and certainly no more.

Kohar Jones is a family physician who blogs at Progress Notes.

via kevinmd.com

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