The Medicare Fraud Strike Force arrested 111 healthcare defendants across the United States on charges relating to Medicare fraud on Thursday, February 17, 2011. This nine city takedown is the largest in U.S. history, utilizing over 700 federal agents in the cities of Baton Rouge, Chicago, Dallas, Detroit, Houston, Los Angeles, Miami, New York, and Tampa. Launched in March of 2007, the Medicare Fraud Strike Force is multiagency effort led by the Department of Health and Human Services with other agential support of the Inspector General, the Federal Bureau of Investigation, along with attorneys from the Department of Justice.

A large percentage of these cases appeared to involve doctors or practitioners acting alone or with a few alleged co-conspirators. The three of most common types of fraud detected have been violations of the federal Anti-Kickback statutes, fraudulent billing practices whereby unnecessary healthcare services or the billing of services that were never performed, and “Unbundling.” Allegations of mail fraud, falsification of records relating to health care matters, money laundering, identity theft, and/or conspiracy were other charges in this Medicare fraud takedown.

Anti-Kickbacks / Stark Law

Anyone who knowing pays, offers to pay, solicits, or receives a kickback for the referral of Medicare patients to a home healthcare agency, or a Medicare beneficiary who knowingly accepts unnecessary services or recruits other Medicare beneficiaries into the scheme is in violation of the federal Anti-Kickback statutes.

Fraudulent Billing Practices

Billing Medicare beneficiaries for unnecessary home healthcare services or for services that were never rendered to the patient, in turn making the patient look sicker than reality and in need of greater care thereby increased the payments the doctor or home health agency would receive from Medicare is fraud.

Unbundling

Certain medical procedures may have many steps in completion of the treatment and accordingly should be billed as one service. To unbundle such procedures into many treatments whereby Medicare would be billed for many separate procedures causing an increased total Medicare reimbursement for that doctor/home healthcare agency is a violation under Medicare.

Lavelle Law, Ltd. believes that the Office of the Inspector General and the Federal Bureau of Investigation will continue to be active in enforcing these restrictions. There is a tremendous amount of pressure to eliminate waste in Medicare. All marketing practices of Medicare providers need to be reviewed in light of these ongoing investigations.