Federal health care fraud enforcement authorities announced last week that they successfully carried out another major national health care fraud sting which they say is the largest of its kind. According to a Press Release by the Department of Justice, efforts by the joint Medicare Fraud Strike Force have resulted in the arrest of 91 defendants for allegedly submitting a collective $295 million in fraudulent Medicare claims. The arrests involve a broad range of health care businesses — including physicians. Some of the charges identified in the Press Release include: -A doctor in Detroit allegedly billed Medicare for performing psychotherapy treatments more than 24 hours per day and providing services to dead beneficiaries. -The owner of a healthcare referral business in Houston is being charged with recruiting, in exchange for kickbacks, Medicare beneficiaries for approximately 100 different home healthcare agencies. -A supervisor at a community mental health center in Miami is being charged with submitting over $50 million in fraudulent billings to Medicare and allegedly threatening to evict residents of a boarding house he also managed, unless they attended the center. A registered nurse, mental health counselors, and other healthcare professionals are being charged with participating in the same scheme. This is just more evidence that the Obama administration intends to make good on its promise to crackdown on Medicare waste, fraud and abuse. Enforcement is and will continue to be a regular component of the delivery of health care services that providers must come to grips with. The only effective insurance against a catastrophic refund or investigation is to have an effective compliance program. Unfortunately, physicians who are still not taking compliance seriously (and there are many) are likely in for a rude awakening at some point – probably in the not so distant — future.
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