Medicare Advantage

Medicare Fraud Crackdown

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A sweep of Medicare fraud nationwide has resulted in the largest takedown of criminal activity in the program’s history. According to the Department of Justice on Wednesday, 300 people have been indicted in various schemes resulting in approximately $900 million worth of fraudulent billing. About half of these schemes involved home health fraud.

Bilking federal programs out of money has become a common scheme among fraudsters, with criminals running scams for years before they’re caught. Medicare in particular has been the target of increasingly costly scams.

In February, a nurse in Pennsylvania was convicted on four counts of health care fraud totaling $9 million. That same month, three physicians in Florida were charged with signing unnecessary prescriptions in order to earn kickbacks worth an average of about $150 a patient.

The DOJ sweep covered states and communities across the country, including the Dallas area, where a husband and wife team managed to scam Medicare out of $5 million with false ear care services. The couple, Harland Hill and Latecia Hill, offered ear screenings to nursing home residents – with or without patient approval or consent. They were able to bill for services that they never provided. They also used untrained medical assistants to administer screenings. Victims of their scam were all diagnosed with the same medical condition, sensorineural hearing loss.

Three other health care offices in the Dallas area were also implicated in the sweep. The owners and several employees of Elder Home Health Services, Molina Medical Housecall Services and Boomer House Calls are being investigated for fraudulent billing and unnecessary charges.

Between January 2013 and May 2016, Celestine Okwilagwe, who owns Elder Home Health Services in Garland, billed Medicare for $3.4 million worth of bogus claims. Hector Molina, owner of Molina Medical Housecall Services, has been charged with 11 counts of fraud in addition to one count of aggravated identity theft. The identity theft charge alone amounts to $26.8 million between January 2010 and April 2015.

Other cases across the country run the gamut from illegal payments and false physical therapy billing to pharmacy fraud. In fact, 25 percent of the cases in the recent DOJ takedown involve pharmacy fraud of some kind. In New York, owners of physical therapy clinics have been charged with laundering money, taking kickbacks, and billing Medicare and Medicaid for unnecessary services.

Attorney General Loretta Lynch announced the DOJ’s crackdown on June 22. That same day, Medicare trustees released a report saying that Medicare would become insolvent by 2028, two years earlier than previously projected. Medicare officials continue to look for ways to reduce fraud as part of the president’s commitment to making the program more efficient under the Affordable Care Act. The DOJ takedown could send a message to would-be fraudsters about the consequences of Medicare scams.