Keeping you updated on the latest Medicare and Part D news

Medicare Fraud Takedown Results in 243 Arrests

Leave a comment

On June 18th, Attorney General Loretta E. Lynch and Department of Health and Human Services (HHS) Secretary Sylvia Mathews Burwell announced a nationwide sweep led by the Medicare Fraud Strike Force across 17 districts that led to the arrest of 243 individuals for their alleged participation in Medicare fraud schemes. The 243 individuals are accused of producing approximately $712 million in false billings spanning across various medical treatments and services, including home health care, psychotherapy, physical and occupational therapy, durable medical equipment and pharmacy fraud.  Among the 243 individuals arrested, at least 44 are charged with fraud related to Medicare prescription drug benefits under Part D.

The arrests came shortly after an HHS Office of Inspector General (OIG) report titled, “Ensuring the Integrity of Medicare Part D,” in which the OIG outlined a number of vulnerabilities to fraud that exist within the Part D program. Among the potential fraud vulnerabilities outlined were the billing of non-rendered services, drug diversion, and an increase in organized criminal networks committing health care fraud, including medical identity theft. Additionally, the OIG had 540 pending complaints and cases involving Part D as of May 2015, a 134% increase in the last 5 years.

The OIG report stresses the evident vulnerability of Part D to fraud schemes that often result in beneficiaries being victimized or being complicit.  The recommendations to curb Part D fraud schemes going forward include requiring sponsors to report all potential fraud and abuse to CMS and/or MEDIC, requiring sponsors to report data on all incidents filed and corrective actions taken related to fraud and abuse, and implementing greater restrictions to ensure certain providers and beneficiaries are limited in their prescription access.

OIG Report
DOJ Report


Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Google+ photo

You are commenting using your Google+ account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )


Connecting to %s