Medicare Fraud Schemes Evolve Amid Rising Prosecutions, Senate Panel Reveals By Tod Aronovitz | 04/17/14 | 0 Comment

Although we never seem to run out of ARONOVITZ LAW blog stories about Medicare fraud prosecutions in Miami, some frustrating conclusions have been brought to light at a recent Senate hearing by the Special Committee on Aging, according to a March 26 article in the Miami Herald. The committee estimated the tab for this fraudulent activity runs taxpayers $60 billion to $90 billion each year.

Notable successes in fighting fraud have brought results. The Senate panel highlighted data that showed prosecutions of health care fraud reached a new high in fiscal 2013 with 377 prosecutions—up 3 percent from the previous year. The data, which was analyzed by Syracuse University’s Transactional Records Access Clearinghouse, came directly from the Justice Department.

In addition, the data was ranked in relation to the nation’s 94 federal judicial districts on their prosecutions under the nation’s health care fraud law. The Southern District of Florida, in Miami, dropped to the second-highest number of prosecutions with 8.8 per one million people. The Southern District of Illinois in East St. Louis, which had 10.1 prosecutions per million people, led in prosecutions.

However, Brian Martens, assistant special agent-in-charge for the government’s Medicare agency based in Miami, told the panel that Miami is still considered the hot spot for Medicare fraud, even though statistics show stepped-up efforts have produced respectable results in combating this activity.

The quandary, he testified, is that Medicare fraud schemes quickly evolve and shift focus depending on where law enforcement targets its resources. Organized crime is frequently involved, making these crimes perilous. Common tactics include paying kickbacks to recruiters for finding patients and providing unnecessary services.

“The criminals committing these crimes are often dangerous, and we regularly encounter stockpiles of weapons when we execute arrests and enforcement operations,” Martens said at the hearing. “These criminals are taking advantage of those most vulnerable in our society—the elderly and the disabled,” he added.

Martens, who works for the inspector general at the Department of Health and Human Services which oversees Medicare, has also noticed that while government criminal prosecutions and monetary recoveries have increased, certain kinds of fraud has decreased, according to the article.

He alluded to the example of community mental health centers and the decrease in payments following special enforcement action and resulting publicity. Nationwide, Medicare payments for the centers fell from an annual $273 million to $31 million, he said.

His final appeal was for more resources for his unit. “We don’t have the staff that we need with the amount of fraud that goes on,” he said.

Committee Chairman Bill Nelson, D-Fla., called the hearing to assess anti-fraud enforcement measures and determine whether investigators need more resources or legal authority to stop criminals from swindling the Medicare program and its patients.

He said, “We can’t afford to lose this much of taxpayers’ hard-earned dollars to fraud, and it’s clear we can’t arrest our way out of a problem of this magnitude.”

How to Report Miami Medicare Fraud

Healthcare professionals or medical billing employees who have knowledge of questionable Medicare billing practices can file a confidential legal claim under the False Claims Act. By acting as a “whistleblower” in what is known as a “qui tam” lawsuit, a private party may collect between 10 to 30 percent of the amount recovered, depending on how the case is prosecuted.

ARONOVITZ LAW: Miami Whistleblower / Qui Tam Law Firm

The Miami Qui Tam law firm of ARONOVITZ LAW routinely works with whistleblowers to document Medicare fraud and other forms of fraud against the government. Contact Miami Whistleblower / Qui Tam lawyer Tod Aronovitz to discuss your case.