Healthcare Fraud Cracking Down on Medicare and Medicaid Fraud

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The Department of Justice recently announced what it called the largest healthcare fraud sting in American history, charging 94 people with defrauding the Medicare and Medicaid programs.

According to the Washington Post, federal agents in five states arrested defendants accused of bilking Medicare of more than $250 million by submitting phony claims for unnecessary services or procedures that were never provided.

Some of those facing charges are doctors, health care company owners and executives.

Lining Up for Kickbacks

A single scheme allegedly operated out of a New York clinic involved $70 million, with cash kickbacks given to Medicare beneficiaries who lined up for illegitimate payments.

According to the Los Angeles Times, Attorney General Eric Holder said the crackdown begun in May of 2009 has thus far resulted in more than 580 criminal convictions and a recovery of more than $2.5 billion in fraudulently obtained funds.

Holder says the criminal activities targeting Medicare and Medicaid drive up health care costs and threaten the long-term solvency of these crucial societal safety nets.

"Our health care system is essentially under siege by criminals intent on lining their own pockets at the expense of the American taxpayers," Holder said.

Cracking Down

In late September, the U.S. House of Representatives passed strict new legislation aimed at corporations found guilty of Medicaid or Medicare fraud. The bill would also target executives in charge of those companies when violations take place.

  • The bill would enable the government to effectively ban CEOs and other executives who engage in fraud from dodging punishment by leaving the company before fraud is proven. The new law, if passed by the Senate and signed by the President, would keep those in management from working in the industry again.
  • The legislation is also designed to knock down shell companies set up to shield parent companies from real penalties related to fraud.

Legitimate Claimants Harmed by Fraudsters

Medicare and Medicaid fraud does more than steal money from hardworking taxpayers. It also casts a shadow over all legitimate beneficiaries, including those who have been injured due to someone else's negligence or wrongdoing.

Those who have knowledge of false claims are advised to enlist the aid of an experienced whistleblower lawyer who can assess the facts of the matter and help determine if a potential reward is available.