July marked the largest health care fraud takedown in history, as the Department of Health and Humans Services (HHS) Office of Inspector General (OIG) charged individuals in multiple schemes involving $1.3 billion in false billings to Medicare and Medicaid.
More than 400 individuals were charged in 41 federal districts in July for allegedly participating in false billings schemes. The takedown was conducted by the Medicare Task Force and 30 state Medicaid Fraud Control Units.
Schemes, both regional and viral, ranged from overprescribing unnecessary narcotics to patients to doctors fraudulently billing Medicare for reimbursements to the tune of millions of dollars.
Major home health schemes were uncovered in Florida, where 77 defendants were charged with offenses in various schemes involving more than $141 million in false billings for home health care services, mental health services and pharmacy fraud. In Illinois, 15 individuals were charged in cases related to six schemes concerning home health services and physical therapy fraud, according to the Justice Department. The schemes reached $12.7 million in fraudulent billing, with one case allegedly involving $7 million in fraudulent billing for home health care services that were not necessary nor rendered.
“Too many trust medical professionals like doctors, nurses and pharmacists have chosen to violate their oaths and put greed ahead of their patients,” Attorney General Jeff Sessions said in a statement. “Amazingly, some have made their practices into multimillion dollar criminal enterprises. They seem oblivious to the disastrous consequences of their greed. …The consequences are real: emergency rooms, jail cells, futures lost and graveyards.”
One of the biggest home health fraud schemes in 2017 include a mother-daughter duo who were sentenced to 10 years in prison for their roles in a $20 million fraud scheme. The two were co-owners of seven Miami-area home health care agencies.
Fraud across the home health care industry has become a contentious issue over the last several years, as new regulations aiming to crack down on billing abuses and fraudulent filings have rolled out.
Pre-Claim Review Demonstration (PCR) is one new regulation that intended to reduce fraud, but was met with enormous outcry from providers. The demonstration, which had begun in Illinois in 2016 and was set to roll in four other states, has since been put on hold.
Fighting fraud has proven to be a good investment; for every $1 spent on these investigations, more than $5 is recovered, according to HHS OIG.
Written by Amy Baxter