Federal officials announced Thursday the largest coordinated, criminal Medicare fraud takedown—and the first large-scale effort to focus on Medicare Part D fraud—in the history of the U.S. Justice Department.
Over the last three days, the Medicare Fraud Strike Force has unveiled charges against 243 individuals across the country accused of falsely billing $712 million to Medicare in a number of separate schemes, said U.S. Attorney General Loretta Lynch. Those charged include 46 doctors, nurses and other licensed medical professionals.
More than 44 of those arrested have been charged with fraud related to Medicare Part D, which is Medicare's drug benefit program.
Lynch said the arrest of those involved in alleged Medicare Part D fraud “demonstrates an expanded federal focus on this important issue.”
HHS Inspector General Daniel Levinson noted that costs in Medicare Part D reached $121 billion last year.
“Our focus on Medicare Part D continues because more than 41 million Americans depend on that program, and its integrity must be protected,” Levinson said.
Kevin Ryan, a member of law firm Epstein Becker & Green, said it's not surprising that there hasn't been as much enforcement of Medicare Part D fraud as there has with other parts of Medicare before now because the program is relatively new. Medicare Part D was implemented in 2006.
"I think you can expect enforcement in all parts of Medicare, and the fact that there's now been major enforcement in Part D just goes to show you there are not sections or parts of Medicare that are exempt from enforcement when it comes to fraud,” Ryan said.
Jessica Gustafson, a founding partner of the Health Law Partners, agreed that it's possible this is the first large-scale effort to focus on Part D fraud just because that program is relatively new. She said her practice has seen a lot of fraud enforcement in the pharmacy area lately.
Also, prosecuting fraud in Part D can sometimes be more difficult than in other areas of Medicare because Part D payments are capitated, rather than fee-for-service, said Patrick Burns, co-director of the Taxpayers Against Fraud Education Fund.
However, Burns also said the government's overall announcement Thursday may not be as impressive as it first sounds. Many civil fraud cases in healthcare involve much larger dollar figures than those touted Thursday. Plus, Burns pointed out that although false billing amounted to $712 million, Medicare wouldn't likely have paid more than half that amount had all the billings actually gone through.
“This is not a record healthcare bust in any way, shape or form,” Burns said. He added that it's frustrating to see the government prosecute small-time fraudsters while sometimes giving a pass to large companies.
“Nobody goes to jail. Nobody loses their job,” Burns said of fraud cases involving large companies. “They hammer the little guys, which they should, but they give the thumbs up and the big wink to the biggest liars, cheats and thieves.”
Tony Maida, a health partner at McDermott Will & Emery and a former deputy chief of the administrative and civil remedies branch of HHS' Office of Inspector General, also noted in a statement that the announcement Thursday “was packaged together by the government to create a high level of media and public exposure, as well as for a deterrent effect.”'
The 243 individuals accused in this latest federal effort to crack down on fraud were charged with a variety of crimes, including conspiracy to commit healthcare fraud, violating the anti-kickback statute, money laundering and aggravated identity theft in areas including home healthcare, psychotherapy, physical and occupational therapy, durable medical equipment and pharmacy fraud.
The cases are being prosecuted and investigated by Medicare Fraud Strike Force teams from the Fraud Section of the Justice Department's Criminal Division and from U.S. attorney's offices around the country.
