by Christine Woolstenhulme, QCC, QMCS, CPC, CMRS
June 23rd, 2016
CNN reported an astounding number of individuals charged with false billing. There was about $900 million in false billing that involved Medicare and Medicaid fraud. Along with the $900 in false billing, $36 million in Detroit involved a front for a narcotics diversion scheme. There were 301 defendants charged in the United States involving 61 medical professionals’ 36 Federal Judicial districts and 28 doctors were charged.
Who is it hurting you ask, who are the victims? It hurts the most vulnerable in our society, the elderly, children that are in need of medical care and the professionals that commit the fraud, but it does not end there. Healthcare fraud inevitably translates into you paying higher insurance premiums and higher out-of-pocket expense's, for you and your family.
Healthcare professionals promise cures, medications and therapies, and the patient never receives the care, patients are exploited and subject to unsafe medical practices. Some of the charges include numerous crimes, including conspiracy to commit health care fraud, violations of anti-kickback statutes, money laundering and aggravated identity theft. CNN also identified what they call “Hotspots” where they believe home health care fraud is committed more often.
CNN reports, a doctor in Texas has been charged with participating in schemes to bill Medicare for "medically unnecessary home health services that were often not provided."
Part D, the drug prescription program has alarming new evidence if identity theft, including the use of stolen doctors IDs used to give fake prescriptions, according to the justice department. This is a trend that is very concerning to the OIG. You may be surprised how close this hits to home, read the entire news article visit cnn.com/2016/06/23/health/health-care-fraud-takedown.