FBI Medicare Fraud Takedown sees 243 Arrested

A multi-city coordinated FBI Medicare fraud takedown has been successfully executed, resulting in 243 individuals suspected of healthcare fraud being arrested. This is not the first large-scale operation targeting healthcare fraud, but it is the most successful, resulting in the highest total of arrests of any Medicare Strike Force operation to date.

The takedown also involved bringing in individuals responsible for the highest total loss amount of any previous operation. The criminals apprehended have allegedly obtained an estimated $712 million from fraudulent Medicare billing.

HHS Assists with FBI Medicare Fraud Takedown

The operation was conducted by Medicare Strike Force teams, the Department of Justice (DoJ) and the Department of Health and Human Services (HHS), with assistance received from local law enforcement officers.

The Medicare Strike Force has previously targeted locations where Medicare fraud appeared to be concentrated; however this takedown was on a national scale. In order to be able to pull off such a large scale multi-city operation, additional staff were required. The FBI also “leveraged technology to collect and analyze data,” according to FBI Director James B. Comey. This enabled the Strike Force teams to identify the persons responsible and orchestrate the takedown, using “rapid response teams to surge where the data showed the schemes were operating.”

Since the Medicare Strike Force was formed in 2007, more than 400 medical professionals have been apprehended for Medicare fraud and more than 200 doctors have been arrested. The total value of fraud that the task force has tacked is estimated to top $7 billion over the 8 years that the Medicare Fraud Strike Force has been operational.

Part of the reason for what Attorney General, Loretta Lynch, called “extraordinary figures,” was the change from using Task Force locations to organizing a takedown on a national scale. The districts outside of the Task Force locations were responsible for 82 of the 243 arrests. Over 900 staff took part in the Medicare fraud crackdown during the three day initiative.

Comey said “We followed the money and found criminals who were attracted to doctor’s offices, clinics, hospitals, and nursing homes in search of what they viewed as an ATM.”

Medical Professionals Recruited By Criminals to Supply Data for Medicare Fraud

Many cases involved insiders within the healthcare industry who provided the necessary information about Medicare beneficiaries to their criminal counterparts, who subsequently prepared and submitted fraudulent bills to Medicare. 46 of the individuals arrested were licensed medical professionals, and 19 doctors were arrested during the takedown.

A high proportion of the cases involved fraudulent billing for medical equipment, or for home care health and mental health services that were not required or not provided. 44 claims related to the Medicare Part D prescription drug benefit program.

In a number of cases, patients were instructed on the questions and answers to provide doctors to ensure they were thought to be eligible for Medicare services. One of the individuals arrested allegedly managed to obtain $4 million from making fraudulent Medicare claims.

243 individuals may have been arrested in the latest FBI Medicare fraud takedown, but as Comey pointed out “There is a lot of money there, so there are a lot of criminals.” Tackling Medicare fraud requires a continued effort.

HHS Secretary, Sylvia Mathews Burwell, worked closely with the FBI during the investigation and said in a press release that “We [the HHS] will work tirelessly to prevent these programs from becoming targets and fight fraud wherever we find it.”

Author: Richard Anderson

Richard Anderson is the Editor-in-Chief of NetSec.news