Feds Bust 243 People In Biggest Medicare Fraud Yet

In what the U.S. Department of Justice is calling the largest nationwide crackdown on Medicare and Medicaid fraud ever, some 243 people were recently arrested and charged for bilking Medicare out of $712 million. Those charged include 46 doctors, nurses, and other licensed medical professionals.

The crackdown was unique not only for its scale, but also as one of the first to focus on fraud in Medicare’s Part D prescription drug program, which started nearly a decade ago. In one Michigan case, for example, a doctor prescribed narcotics in exchange for patients' identification information that he used to generate false Medicare billings. As the patients became hooked to the prescription narcotics, they were trapped in the scheme if they wanted to keep their access to the drugs.

A new report by the Inspector General of the Department of Health and Human Services provided a first look at the extent of fraud in Medicare Part D.

More than 1,400 pharmacies had questionable billings in 2014. Some of the pharmacies billed for extremely high numbers of prescriptions per patient, and others billed for a high portion of prescription narcotics. Collectively they billed Part D for $2.3 billion in 2014.
Spending for commonly abused prescription opioids grew at a faster rate than spending for all other drugs. Prescription opioids like OxyContin, hydrocodone-acetaminophen, and morphine sulfate are narcotics intended to manage pain from surgery, illness, and injury. Since 2006 growth in spending on these drug grew by 156%, while growth in spending on all other Part D drugs was 136%.

"remains vulnerable to fraud that could be mitigated or avoided through better oversight. These investigations have uncovered serious medical harm to individual patients and financial harm to the Overall Part D program."

TSCL applauds the recent crackdown action, but, as Executive Director Shannon Benton notes, "The Centers for Medicare and Medicaid Service needs to do more to keep the crooks out of Medicare. This is just the tip of a huge iceberg. Fraud has been estimated to cost Medicare beneficiaries and taxpayers as much as $60 billion a year."

Sources: "Authorities Arrest 243 People In $712 Million Medicare Fraud,” Megan Cassella, Reuters, June 18, 2015. "National Medicare Fraud Takedown," Department of Justice, June 18, 2015. "Questionable Billing And Geographic Hotspots Point To Potential Fraud And Abuse In Medicare Part D," Department of Health and Human Services Office Of Inspector General, June, 2015.