HHS, DOJ Recover $4.3B in Fraud

Latest report details various instances of Medicare fraud, but doesn’t focus on DME as the central cause.

The federal government recovered $4.3 billion in 2013 as part of its anti-Medicare fraud efforts, according to “Health Care Fraud and Abuse Control Program Annual Report for Fiscal Year 2013,” the Departments of Justice and Health and Human Services annual anti-fraud report.

The full report can be downloaded as a PDF at:
http://oig.hhs.gov/publications/docs/hcfac/FY2013-hcfac.pdf

Some other pieces of summary data:

  • Of this $4.3 billion, the Medicare Trust Funds received transfers of approximately $2.85 billion as a result of the anti-fraud efforts.
  • More than $576 million in Federal Medicaid money was similarly transferred separately to the Treasury as a result of these efforts.
  • During fiscal year 2013, the Department of Justice opened 1,013 new criminal healthcare fraud investigations.
  • A total of 718 defendants were convicted of health care fraud-related crimes during the year.
  • Federal Bureau of Investigation healthcare fraud investigations resulted in the operational disruption of 425 criminal fraud organizations and the dismantlement of the criminal hierarchy of more than 115 criminal enterprises engaged in healthcare fraud.

 

Also noteworthy is the fact that HME providers are not singled out in the report’s summary of key anti-fraud operations. A number of  highlighted cases involve a variety of healthcare industry players.

“The report mentions several stories of DME recoveries, yet there are many more stories involving hospitals, nursing homes, physician practices, and home health agencies,” a statement from the American Association for Homecare noted. “While fraud continues to be a focus, DME is not targeted as the main culprit.”

That said, the report provides several cases of significant DME fraud. A few examples:

  • A former officer of Los Angeles provider Fendih Medical Supply Inc. and a physician were respective sentenced to 51 months and 27 months for their parts in a DME fraud scheme that amounted to $1.5 million in bogus Medicare claims.
  • The owner of a Houston provider was sentenced to 97 months in prison and ordered to pay $2.5 million in restitution after being convicted for a $6.7 million Medicare fraud scheme.
  • A California DME company owner and operator was sentenced to 156 months imprisonment and ordered to pay $8.2 million in restitution after being convicted for collecting $8 million after submitting $16 million in fraudulent claims.

 

About the Author

David Kopf is the Publisher and Executive Editor of HME Business and DME Pharmacy magazines. Follow him on Twitter at @postacutenews.

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