Medicare Epic $700 Million Fraud Bust


Medicare is a form of government-funded insurance that is supposed to start covering a person as soon as they reach the age of 65. It is in place to supplement the elderly as they reach the retirement age. However, there have been reports of health care professionals taking advantage of these funds. There was recently an epic bust on those committing fraud against Medicare at amounts over $700 million.

The Centers for Medicare and Medicaid Services explain that there is no premium with this insurance because it was paid into from a working person’s taxes. Medicare Part A is in place to cover a patient’s hospital services. Part B covers other medical expenses like supplies or home health care, but there is often a premium paid by the recipient. Prescription drug coverage, or Part D, is usually provided by a private company and a premium is paid.

NPR reported that 243 people were arrested for committing fraud against the Medicare system for more than $700 million. The arrests were made by the FBI over a three-day time period. They involved several different cases around the country and included many forms of defrauding the system.

Fox Business claimed that Miami was the center for the most cases and the most amount of money. Fraud here was largely the result of falsifying mental health services and pharmacy services. Medicare was outed approximately $263 million in Miami alone.

Fox Business shows the city that criminals made the second most in was Detroit with $122 million in fraudulent earnings. Here, the primary sources were doctors writing unnecessary prescriptions and hospice being paid kickbacks for referrals.

MedicareThis was an epic bust on those committing Medicare fraud. However, deception is so prevalent that the U.S. Department of Health and Human Services feels the need to warn those on the insurance about the signs of schemers. They caution members should be wary if told tests become cheaper the more a person has them. A more obvious account they give is being billed for a service one did not receive or a diagnosis a person does not have. With these guidelines, the government is hoping patients will be able to pick up on deceit themselves.

Reports confirm that to commit fraud in a pharmacy, employees often bill for a brand name medication costing hundreds of dollars while they dispense a generic version to the customer. If this happens frequently enough it can turn a huge profit for the pharmacy. At a time when concerns over funding for Medicare going forward have been questioned in the news repeatedly, these reports can be particularly disheartening to some.

Forbes has claimed that Medicare fraud is costing the American taxpayers billions of dollars. This latest bust was reported at upwards of $700 million in stolen taxpayer money. In the same article, they state that Russian and Nigerian mobs have started getting involved with defrauding these programs. Many have moved to Florida to practice where it has proven to be more lucrative.

Forbes describes the 2010 report by the Government Accountability Office showing where in that year alone they uncovered $48 billion in fraudulent transactions. The article also says that catching the criminals after the act has been committed is too late and most of the money is already lost.

While this latest bust on Medicare fraud was epic in its size, it was still only $700 million while it is being reported that billions are being stolen each year. It has been recommended that authorities find ways to stop the fraud before a claim has been billed and the money paid out.

By Megan Hellmann
Edited By Leigh Haugh

Fox Business–Feds Announce Largest Ever Criminal Medical Fraud Takedown
NPR–Doctors and Nurses Among 243 Charged in Million-Dollar Medicare Schemes
U.S. Department of Health and Human Services–Stop Medicare Fraud
Forbes–Medicare and Medicaid Fraud Is Costing Taxpayers Billions
Photo Courtesy of Marcel Oosterwijk’s Flickr Page – Creative Commons License
Photo Courtesy of Clean Wal-Mart’s Flickr Page – Creative Commons License