According to the Associated Press, Federal authorities charged 111 doctors, nurses and physical therapists in nine cities with Medicare fraud Thursday, part of a massive nationwide bust that snared more suspects than any other in history.
In all the 111 health care providers defrauded Medicare of more than $225 million. The arrests are the latest in a string of major busts in the past two years as authorities have struggled to pare the fraud that's believed to cost the government between $60 billion and $90 billion each year, according to the AP. Stopping Medicare's budget from hemorrhaging that money is a key component of President Barack Obama's Affordable Care Act legislation.
Attorney General Eric Holder stated that the Medicare fraud busts in Miami, Los Angeles, Dallas, Houston, Detroit, Chicago, Brooklyn, Tampa, Fla., and Baton Rouge, La. show that "health care fraud is not easy money."
Fraud Examples:
- A podiatrist performing partial toenail removals was among 21 indicted in Detroit. Dr. Errol Sherman is accused of billing Medicare about $700,000 for the costly and unnecessary procedures, which authorities said amounted to little more than toenail clippings. The podiatrist billed Medicare for 20 nail removals on three toes of one patient, according to the indictment. He charged Medicare about $110 for each procedure.
- A Brooklyn, N.Y., proctologist was charged with billing $6.5 million for hemorrhoid removals, most of which he never performed. Dr. Boris Sachakov claimed he performed 10 hemorrhoid removals on one patient, which authorities said is not possible.
Medicare Fraud Targeted in Affordable Care Act
Kathleen Sebelius, Secretary of the Department of Health and Human Services, has promised more decisive action on the front end, by vigorously screening providers and stopping payment to suspicious ones, under greater authority granted by the Affordable Care Act.
According to Healthreform.gov, the Affordable Care Act expands efforts to prevent, detect and take strong enforcement action against fraud in Medicare, Medicaid and the Children’s Health Insurance Program as well as private insurance. The new law contains:
- Tough New Rules and Sentences for Criminals: The Affordable Care Act directs the Sentencing Commission to increase the Federal sentencing guidelines for health care fraud offenses by 20-50% for crimes that involve more than $1,000,000 in losses. The law makes obstructing a fraud investigation a crime and makes it easier for the government to recapture any funds acquired through fraudulent practices.
- Enhanced Screening and Other Enrollment Requirements: The Affordable Care Act provides critical tools for fraud prevention, including new authorities for stepped-up oversight of providers and suppliers participating or enrolling in Medicare, Medicaid, and CHIP such as mandatory licensure checks.
- New Resources to Fight Fraud: The Affordable Care Act provides an additional $350 million over the next ten years to help fight fraud through the Health Care Fraud and Abuse Control Account (HCFAC) from FY 2011 through 2020.
- Sharing Data to Fight Fraud: Building on the Obama Administration initiatives, the law requires the Secretary to expand the Centers for Medicare and Medicaid Services integrated data repository to include information from Medicaid, Veterans Administration, Department of Defense, Social Security Disability Insurance, and Indian Health Service, and enhances data matching agreements among Federal agencies. These agreements will make it easier for the Federal government to share data, identify criminals and prevent fraud.
- New Tools to Prevent Fraud: The Affordable Care Act requires providers and suppliers to establish plans detailing how they will follow the rules and prevent fraud as a condition of enrollment in Medicare, Medicaid, or CHIP.
Medicare fraud has been rampant for decades, particularly since Part B physician services became a benefit with the addition of millions of new providers such as physical therapists, chiropractors, podiatrists, and others. There's a long way to go, but these charges should at the very least, give some questionable practitioners pause.
