More than 100 face federal charges in Medicare fraud investigation

Yesterday, 107 individuals around the country were charged with Medicare fraud. Federal officials claim that the nationwide investigation and crackdown discovered more than $450 million that had been improperly billed to Medicare, making it the largest Medicare fraud investigation ever.

While the investigation was part of a coordinated effort, the suspected fraud schemes discovered by the investigation were unrelated. Over the last three years, the U.S. Attorney General and the Department of Health and Human Services have joined forces and pooled resources in an attempt identify more instances of suspected fraud.

One trend that has gained the attention of federal investigators is allegations of fraud arising out of community mental health centers. Of the $450 million apparently involved in yesterdays operation, about half was attributed to two community mental health centers. Authorities claim that that these centers would find vulnerable patients and then bill Medicare for services for those patients that were never delivered.

Federal authorities have touted their increased enforcement efforts. The number of strike teams around the country has been quadrupled in the last few years. Federal enforcement agencies have also developed a new information system that is designed to review large numbers of submitted bills and automatically flag questionable patterns.

With such a rapid and large scale increase in federal enforcement efforts, it may be more likely than ever that innocent individuals may be drawn into the dragnet. There is potentially even more risk as law enforcement officials begin to rely on computer algorithms as the basis for their fraud allegations.

Source: Atlanta Journal Constitution, “107 charged in Medicare fraud busts in 7 cities,” Pete Yost, May 2, 2012