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DOJ indicts 53 accused of Medicare fraud

[JURIST] The US Department of Justice (DOJ) [official website] announced indictments [press release] Wednesday against 53 health care providers and beneficiaries accused of submitting $50 million in fraudulent Medicare [official website] claims. The indictments, returned by a grand jury in Detroit, led to the arrest of suspects in Detroit, Miami, and Denver whom the government alleges billed the federal health care program for treatments that were "medically unnecessary and oftentimes, never provided." US Department of Health and Human Services (HHS) [official website] Secretary Kathleen Sebelius [official profile] said that the efforts of the Health Care Fraud Prevention and Enforcement Action Team (HEAT) [official website] to reduce Medicare fraud were necessary to the financial health of the program.

Our Medicare program is working closely in partnership with our own and other law enforcement operations to prevent fraud from happening in the first place. Every dollar we can save by stopping fraud can be used to strengthen the long-term fiscal health of Medicare, bring down costs and deliver better service to Medicare beneficiaries.

Attorney General Eric Holder [official profile] said that fraudulent Medicare schemes "not only undermine a program upon which 45 million aged and disabled Americans depend, but ... also contribute directly to rising health care costs."

The formation of HEAT, an interagency effort between the HHS, which oversees Medicare, and the DOJ, was announced [press release] in May, as an expansion of the Medicare Fraud Strike Force program aimed at curbing durable medical equipment (DME) fraud in Los Angeles and South Florida. Fraud reduction is part of a larger effort to control the rising cost of the Medicare and Medicaid programs. In October, the US Centers for Medicare and Medicaid Services (CMS) [official website] implemented regulations [text] denying hospitals payment for treating conditions caused by some common medical errors [HHS backgrounder]. The new regulations were authorized by the Deficit Reduction Act of 2005 [text], which directed the HHS to identify reasonably preventable conditions that result in high-cost or high-volume treatment and additional government payments.

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