Federal Government Targets Medicare Fraud

Beginning in 2007 federal, state, and local law enforcement officials came together in South Florida to form the nation’s first Medicare fraud strike force. The goal of the strike force was to track down and prosecute those defrauding the nation’s multibillion dollar Medicare system. From that beginning in South Florida the government formed a second strike force in the Los Angeles area. Now, the investigation and prosecution of Medicare fraud has become a top priority of the Departments of Justice and Health and Human Services as well as state and local law enforcement agencies. The enforcement program has expanded nationwide. To date the initiative has resulted in the indictment of more than 300 health care providers and ended schemes responsible for more than $700 million in false Medicare claims. Most of the cases brought by the government task forces charge kickbacks and false-billing schemes.

Kickbacks are schemes that operate essentially as bribery arrangements where one party provides a payment or some value to a second party for the referral of patients or services covered by Medicare. False-billing schemes are self explanatory and involve claims to Medicare for services that are unnecessary and/or never rendered to the patient.

Before the Senate in May of this year Assistant Attorney General for the Criminal Division Lanny Breuer testified that federal and state spending on Medicare and Medicaid has reached $800 billion annually. Of this amount, various estimates put the loss to waste, fraud, and abuse between three and ten percent.

The 2010 federal budget invests $311 million to bolster the integrity of the Medicare and Medicaid programs. This investment is a 50% increase over the 2009 budget. Estimates suggest that the investment could save $2.7 billion over five years. Moreover, statistics indicate that the number of cases being brought by prosecutors is growing rapidly. Since the program’s inception, the strike forces have filed more than 130 cases, charged 300 people, and convicted dozens in the cases that have thus far been adjudicated.

It is clear that the federal government will continue its emphasis on health care enforcement. In the future the numbers of cases should continue to rise. As a result, it is vitally important that all health care providers ensure compliance with all statutes and regulations. Moreover, it is necessary to contact experienced counsel at the first indication of a government inquiry.

For more information concerning the government health care strike forces, please see The Washington Times, December 1, 2009.

About Richard Serafini

Welcome to my blog. I am an attorney and practice in the area of corporate trial work. Areas of particular emphasis are white collar defense, securities litigation, health care litigation, internal investigations, RICO, and financial litigation. I will be posting interesting developments in my areas of interest. I hope that you find this blog helpful and informative.