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Medicare Strike Force Cracks Down on Fraud

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According to a press release from the Department of Justice, in May 2013, the “Medicare Fraud Strike Force charged 89 individuals, including doctors, nurses, and other licensed medical professionals, for their alleged participation in Medicare fraud schemes involving approximately $223 million in false billings.”

These individuals were from eight different cities, and joined an additional nearly 600 individuals who have been charged in connection with Medicare fraud. According to an October 30, 2013 Medscape report, another physician—former psychiatrist at the Veterans Affairs hospital in Brooklyn, New York—pled guilty to billing Medicare for nonexistent home medical treatments.

Medicare Fraud Strike Force Cracks Down on False Billing

The Medicare Fraud Strike Force has been working for some time now to crack down on false billing. In October 2012, the Department of Justice reported that operations in seven other cities led to charges against 91 individuals involving approximately $429.2 million in alleged fraudulent billing. Attorney General Eric Holder noted that enforcement actions reveal “an alarming and unacceptable trend of individuals attempting to exploit federal health care programs to steal billions in taxpayer dollars for personal gain.”

The joint Department of Justice and Health and Human Services (HHS) Medicare Fraud Strike Force is a multi-agency team of federal, state, and local investigators and prosecutors working to root out Medicare fraud by using data analysis techniques. Typical charges include conspiracy to commit health care fraud, health care fraud, violations of the anti-kickback statues and money laundering.

Psychiatrist Pleads Guilty

Mikhail L. Presman, former psychiatrist at the Veterans Affairs (VA) hospital in Brooklyn, allegedly submitted roughly $4 million in Medicare claims from his private practice between January 2006 and May 2013. These included claims for home visits he supposedly made when he was actually in China, and to patients who were in the hospital at the time.

The charges against Presman were filed as part of the Medicare Fraud Strike Force’s nationwide hunt for those submitting fraudulent claims. The Department of Justice reports that since 2007, the Strike Force has charged more than 1,500 defendants who collectively billed Medicare for more than $5 billion.

Fraud Occurring in Brooklyn

HHS Secretary Kathleen Sebelius credits the Affordable Care Act (ACA) with expanding the HHS’ authority to suspend Medicare payments and reimbursements when fraud is suspected. Court documents reveal the problem as going beyond doctors and other healthcare professionals to include patient recruiters, Medicare beneficiaries, and other co-conspirators who are paid kickbacks in return for supplying key information.

In their May 2013 press release, the Department of Justice noted that in Brooklyn, New York, four individuals, including two doctors, were charged in fraud schemes involving $9.1 million in false claims.