Medicare Fraud Sting Operations by Federal Government Includes Senior Volunteers Spying on Doctors and Health Care Providers: Expect to See More National Stings and Sweeping Arrests of Medical Pros in the Future

Be on the look out for seniors in trench-coats if you’re working in the health care industry:  the federal government has proudly launched its latest weapon against health care fraud:  the “Senior Medicare Patrol.”

Here’s the description of this new “tool to fight fraud, strengthen federal and private health programs, and protect consumer and taxpayer dollars” as reported on HealthCare.gov:

As a part of the new resources dedicated to fighting fraud, the Obama Administration has significantly expanded funding for Senior Medicare Patrols – groups of senior citizen volunteers who educate and empower their peers to identify, prevent and report health care fraud. In 2012, the Secretary awarded 54 states and territories with funding to support the Senior Medicare Patrol programs Last year, these programs taught more than 2 million beneficiaries how to look for Medicare fraud. Local Senior Medicare Patrol offices provide assistance when such issues are identified, so that mistakes are corrected and suspected fraud referred to the appropriate authorities. Since 1997, more than 1.5 million seniors and their caregivers have contacted the Senior Medicare Patrol to ask questions or report potential fraud.

Medicare Fraud Bust in Miami: Example of Federal Government Focus on Medicare Fraud / Health Care Fraud Investigations

Here’s an example of the health care fraud prosecutions that are taking place in the United States right now.  This week, the Federal Bureau of Investigation announced that a therapist, 35 years old, was sentenced this week to 4 years imprisonment in a federal prison and ordered to pay restitution in excess of $72 million by U.S. District Judge Patricia A. Seitz in the Southern District of Florida. .

The woman, Nickole Eckert, lost her fight at a six-week trial in November when a jury found her guilty of Medicare fraud (1 count of conspiracy to commit health care fraud) for her part in a Medicare Fraud Scheme that totalled $205 million according to the investigators with the Department of Health and Human Services.

Eckert pays her restitution to the federal goverment.  Once she gets out of the federal prison, she’s also ordered to be under 3 years of supervised release.  From the FBI release on the sentencing this week:

“Evidence at trial demonstrated that the defendant and her co-conspirators caused the submission of false and fraudulent claims to Medicare through ATC, a Florida corporation headquartered in Miami that operated purported partial hospitalization programs (PHPs) in seven different locations throughout South Florida and Orlando,” according to the Department of Justice.

The Medicare Fraud Scheme here involved conspiracy charges that the defendants filed false (fraudulent) claims for payment from Medicare both for themselves and through a company called the American Sleep Institute and their patients were being treated for severe mental illness.  Evidence was provided at her trial to demonstrate that the Miami therapist “… fabricated therapist notes and other documents for patient files and submissions, and taught others to fabricate them, to make it appear both that ATC patients were qualified for PHP treatment and that they were receiving the intensive, individualized treatment PHP is supposed to be.”

Medicare Fraud and Health Care Fraud Prosecutions Are Big Focus of Federal Government and its Medicare Fraud Strike Force

The federal government is serious about investigating health care providers (doctors, nurses, clinics, hospitals, labs, therapists, home health care companies, etc.) and big Sting Operations have already resulted in national sweeps where large numbers of arrests are made in one big swoop followed by media coverage.  For example:

1.  In October 2012, 91 people were arrested by the Justice Department for Medicare Fraud in Houston, Dallas, Brooklyn, Baton Rouge, Chicago, Los Angeles and Miami.  This included the president of a Texas hospital in Houston (Riverside General).  Scheme: $452,000,000.00.

2.  In May 2012, 107 people were indicted by the Justice Department for Medicare Fraud in seven cities, including Houston, Miami, Baton Rouge, Los Angeles, Detroit, Chicago, and Tampa.  Scheme:  $205,000,000.00.

More Medicare Fraud Arrests Are Going to Happen

Health care fraud defense lawyers in Dallas and across the country are expecting many more federal arrests and federal indictments of medical professionals in the coming years.  We’re not the only ones:  this week, the CEO of Health Care Compliance Association was quoted in the media warning about these federal fraud investigations into the health care industry.  Roy Snell told HealthLeadersMedia this week that this is coming from pressure on the federal government to boost their arrests because (1) cost of health care reform (Obamacare) and (2) the growing national concern about the deficit.

In other words, these Health Care Fraud Stings bring in big money from restitution orders. If they can collect the money from the May 2012 and October 2012 Schemes alone, then the federal government will take in a restitution total of $657,000,000.00.

So, if you practice medicine these days, then you may be wise to check with someone who practices law to make sure you’re doing everything you can to avoid getting caught in one of these nets.

• Remember:  an indictment isn’t a conviction.
• And also remember:  a senior citizen spy from the Senior Medicare Patrol may be watching you.