What is Medicare Fraud?

Medicare fraud occurs when a hospital, nursing home, doctor's office, hospice care facility, ambulance service, pharmacy, rehabilitation center, or any other type of healthcare provider overbills Medicare.


Who can report Medicare fraud?

Medicare fraud whistleblowers are almost always healthcare professionals. They are commonly employed as hospital administrators, nurses, hospice or nursing home workers, ambulance drivers, pharmacists, or as any other type of healthcare professionals.

Receive a financial reward for your information.

Healthcare professionals may be entitled to a significant financial reward for becoming Medicare whistleblowers. Learn about receiving a financial reward for your information here.


91 individuals charged with Medicare Fraud, totaling $295 million in false billing
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In a September 8, 2011 press release the US Department of Justice (DOJ) announced a nationwide bust that charged 91 individuals with Medicare fraud. In all, the group perpetrated almost $295 million in false billing.
The announcement was made by Attorney General Eric Holder and Health and Human Services (HHS) Secretary Kathleen Sebelius. It showed the teamwork at the national level as the two were joined by the FBI’s Executive Assistant Director Shawn Henry, Assistant Attorney General Lanny A. Breuer of the Justice Department’s Criminal Division and HHS Inspector General Daniel R. Levinson.

The nationwide crackdown by Strike Force prosecutors involved indictments yesterday in six cities alleging a variety of Medicare fraud schemes. The 70 individuals charged constituted the largest amount of illegal Medicare billings at one time in the Strike Force’s entire history.

This bust shows the effectiveness of multiple agencies working together to stop fraud in its tracks. The Department of Justice-HHS Medicare Fraud Strike Force is a team of federal, state and local investigators specifically charged to combat Medicare fraud. Their impressive successes rely on the use of Medicare data analysis techniques and a strong reliance on community policing.

“The defendants charged in this takedown are accused of stealing precious taxpayer resources and defrauding Medicare – jeopardizing the integrity of our health care system and our nation’s most critical health care program for personal gain,” said Attorney General Holder. “Our highly coordinated, nationwide Strike Force operations are working aggressively to combat Medicare fraud and our anti-health care fraud efforts have never been more innovative, collaborative, aggressive – or effective. We will continue to work with our law enforcement partners and partners across government to fight against health care fraud.”

Specific charges included conspiracy to defraud the Medicare program, money laundering, health care fraud and anti-kickback statute violations. The fraudulent services claimed by the defendants included treatments and services such as home health care, physical and occupational therapy, durable medical equipment and psychotherapy.

Court documents surrounding the indictments showed typical scenarios that included recruiters obtaining Medicare patients’ information, passing it on to providers who then submitted false claims. Many times the treatments were unnecessary and often not provided at all. Many participants, from recruiters to doctors, nurses and even beneficiaries received kickbacks for their role in the fraud.

South Florida, often involved in these schemes, provided 45 of the charged. All of them, including one doctor and one nurse, were charged with a variety of illegal and false billings for home health care, mental health services, physical and occupational therapy and HIV infusion.

One Miami case involves 24 defendants who allegedly participated in a community health center fraud scheme that resulted in more than $50 million worth of fraudulent submissions. In a particularly strange scenario, recruiters preyed on Medicare-eligible beneficiaries living in halfway houses. Those who refused to participate in the scheme by showing up for appointments in the mental health center were threatened with eviction.

False billings totaling $62 million were alleged to have been made by two individuals in Houston. One indictment showed that a defendant received illegal payments when he allegedly sold beneficiary details to 100 different Houston-area home health care agencies. The agencies then billed for durable medical equipment and other home health care services.

Several doctors were among those charged across the country. Two of them were among six defendants charged in Los Angeles for Medicare fraud schemes amounting to $10.7 million. Brooklyn’s indictments contained another pair of doctors, part of a scheme involving physical therapy services that resulted in $3.4 million of false claims.

In Detroit, three doctors joined an additional 15 defendants charged with defrauding Medicare out of $28 million. One indictment there claimed 14 defendants were part of a home health care scheme that claimed more than $14 million in false claims to Medicare.

The Medicare Fraud Strike Force is the frontline assault arm of the Health Care Fraud Prevention & Enforcement Action Team (HEAT), a joint initiative announced in May 2009 between the Department of Justice and HHS. Their main aim is to prevent and deter fraud and enforce current anti-fraud laws throughout the US.

Since initiating activities in March, 2007, the Strike Force, located in nine cities now, has charged more than 1,100 defendants, who have falsely billed Medicare for more than $2.9 billion.

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