Consumer Fraud

Healthcare fraud crackdown leads to 91 criminal charges involving $430 million

Pills Stethascope on Money 435x289 Healthcare fraud crackdown leads to 91 criminal charges involving $430 millionAnother U.S. government crackdown on Medicare and Medicaid fraud resulted in the criminal charges against 91 health care professionals, including several doctors and nurses, for allegedly cheating the federal programs out of $430 million. The latest sweep was similar in scope to a May crackdown that uncovered more than $450 million in false billing and other fraud directed at federal programs to help the elderly and poor with health care costs. Both sweeps are part of the government’s ramped-up efforts to recover money from the taxpayer-funded programs and deter medical professionals from further fraud, abuse, and waste.

Earnest Gibson, President of Riverside General Hospital in Houston, Texas, was one of the professionals accused of defrauding the government. U.S. authorities say they’ve found $42 million in improper claims on top of another $116 million in earlier fraud at Riverside General, which rewarded patients with cigarettes, food, and other kickbacks if they attended “partial hospitalization programs,” that involved watching television instead of receiving any form of medical services. The hospital then billed Medicare and Medicaid for the programs.

Thirty-three of the people charged last week were involved in false billing at hospitals and clinics in the Miami area, according to U.S. authorities. Other cases of fraud in five other U.S. cities involved billing the government for fictional or unneeded home health services, mental health programs, ambulance rides, and prescription drugs. Some of those charged with fraud were also charged with money laundering and identity theft.

“Today’s enforcement actions reveal an alarming and unacceptable trend of individuals attempting to exploit federal health care programs to steal billions in taxpayer dollars for personal gain,” said U.S. Attorney General Eric Holder in a statement.  “Such activities not only siphon precious taxpayer resources, drive up health care costs, and jeopardize the strength of the Medicare program – they also disproportionately victimize the most vulnerable members of society, including elderly, disabled and impoverished Americans.”

Health and Human Services Secretary Kathleen Sebelius said the arrests “put criminals on notice that we are cracking down hard on people who want to steal from Medicare.”

“The health care law gives us new tools to better fight fraud and make Medicare stronger.  In addition to the arrests made today, HHS used new authority from the health care law to stop future payments to many of the health care providers suspected of fraud, saving Medicare resources and taxpayer dollars from being lost to fraud in the first place,” Secretary Sebelius added.

New technology also played a role in the recent sweeps.

According to a Reuters report, U.S. officials say “the government has improved its ability to detect fraud in real time, using software that evaluates reimbursement requests for potential irregularities.”


U.S. Department of Health and Human Services