Law Enforcement Stepping Up to Fight Medicare and Medicaid Fraud

It is vital for law enforcement to fight health care fraud to protect our citizens and the economy.  Even though there are only a few providers engaging in fraud, it raises the cost of care for everyone.  If we all pitch in together, we can help prevent health care fraud.

As part of the 2019 National Health Care Fraud Takedown effort, our state attorney generals and law enforcement are working diligently to reduce Medicaid fraud.  According to Centers for Medicaid and Medicare Services, Medicaid fraud is intentionally providing false information to defraud Medicaid into paying for medical care or services.   Conversely, Medicare fraud is claiming of Medicare healthcare reimbursement that the claimant is not entitled to.  Both crimes ultimately raise the cost of care.

Louisiana's Attorney General intensified his efforts to fight Medicaid fraud by working with federal and state agencies and made 21 arrests across the state.  In an interview with KALB, General Landry said, “Our Medicaid Fraud Control Unit and law enforcement partners are top notch professionals working to protect our most vulnerable citizens and vigorously prosecute criminals that pray on them.”   General Landry continued by saying, “Medicaid welfare fraud jeopardizes healthcare resources for Louisiana's poor and steals from our state's taxpayers.”

In Florida, Attorney General Ashley Moody's Medicaid Fraud Unit announced the arrests of 19 people who were fraudulently billing Medicaid for over $1 million dollars.  General Moody said, “Fraud of any kind will not be tolerated in Florida. It is sickening to know individuals will use and abuse those under their care. This kind of fraud and abuse not only hurts the direct victim, but it drives up the costs of everyone.”

Alabama's Attorney General Steve Marshall, United States Attorney Jay Town and Office of Inspector General Special Agent, Derrick Jackson announced an arrest of a Birmingham Psychologist charged with defrauding the state out of $1.5 million.  U.S. Attorney Town said, “The greed of the defendant deprived mental health citizens in Alabama, with the focus on profit rather than efficacy of care.” This prosecution shows what a strong team of Federal, State and local officials working together can accomplish.  “This defendant was entrusted to provide essential mental health care for those who were at risk, and to provide these services through an agency with scarce resources for vulnerable Alabamians who are truly in need,” said Attorney General Marshall.

Just last month, federal officials announced charges against 35 people linked to a massive Medicare scam after a CBS investigation revealed how recruiters enticed senior citizens into submitting a DNA sample for a “free” genetic cancer risk test. The individuals charged are accused of submitting more than $2.1 billion in false Medicare claims. Sadly, because of this scam, older Americans may not qualify for legitimate DNA tests in the future

According to HHS, the money taxpayers spend fighting fraud is a sound investment. For every dollar spent on health care related fraud and abuse investigations over the last 3 years, more than $4 dollars has been recovered.

The National Health Care Association estimates the losses due to health care fraud amount to tens of billions of dollars annually.  According to NHCAA, health care fraud is a serious crime that affects everyone and neither government officials, taxpayers insurers, health care providers, or patients can afford to overlook it.

It is important to know, we can all pitch in to help prevent health care fraud.  The FBI offers these tips to protect yourself from unscrupulous health care fraudsters:

  • Be informed- Be informed about the services you receive. Keep good records and closely review all bills you receive.

  • Safeguard your health insurance ID Card and Benefit Information- Protect your card the way you protect your credit card. If your information ends up in the wrong hands it could be a license to steal.  Be vigilant with your information especially to telephone telemarketers, door to door sales people or over the internet.  If you lose your insurance ID card, report it immediately.

  • Be aware of your surroundings and free offers- Be aware of your surroundings in medical facilities and be sure everything looks legitimate. Be aware of free offers.  Offers for free services are often disguised as fraud schemes designed to bill you and your provider for services you never received.

  • Check Medial Supplies- Make sure you receive exactly what you ordered. For example, did you order a power wheelchair and they sent a cheap scooter?

If you suspect health care fraud, contact your insurance company.  If you suspect Medicare or Medicaid fraud, contact the Office of Inspector General's National Fraud Hotline at 1-800-447-8477 or 1-900-HHS-TIPS.


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