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.


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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.

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Medicare Strike Force charges 53 for Medicare Fraud
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The US Department of Justice, in a June 24, 2009 press release, told of Medicare Fraud Strike Force operations that netted charges against health care executives, 53 doctors and Medicare beneficiaries. The actions of those charged allegedly resulted in false Medicare billings of $50 million in Detroit.

Today’s announcement was made by officials from the DOJ, Department of Health and Human Services (HHS) and the FBI. The Detroit Strike Force is the third phase of the group’s assault targeting individuals and health care companies attempting to defraud the Medicare program.

Although a Detroit grand jury served the indictments, arrested individuals lived in Detroit, Miami and Denver. The joint efforts of DOJ-HHS comprise a multi-agency group from all levels of local, state and federal government.

"As demonstrated by today’s charges and arrests, we will strike back against those whose fraudulent schemes not only undermine a program upon which 45 million aged and disabled Americans depend, but which also contribute directly to rising health care costs that all Americans must bear," said Attorney General Holder. "The vast majority of doctors, patients, and medical companies do the right thing and work with the Medicare program to provide access to medical services. To those who work diligently and ethically to provide medical care through the Medicare program, we will work with you to root out the few who corrupt the system and taint the good reputations of health professionals everywhere."

The Medicare Strike Force was formed in 2009, as a part of the Health Care Fraud Prevention & Enforcement Action Team (HEAT). The team was established to enable law enforcement and prosecution teams to cooperate across state lines and is credited with sizeable successes in the past several years.

The indictments today contained a variety of charges, including conspiracy to defraud the Medicare program, criminal false claims and violations of the anti-kickback statutes. The Detroit sting was focused in two major areas, infusion therapy and physical/occupational therapy companies.

The indictments charged that many of the schemes perpetrated were for treatments deemed unnecessary and, in many cases, not even delivered. Beneficiaries participated by providing their personal and Medicare information in exchange for cash kickbacks.

In all, the physicians, medical assistants, patients, company owners and executives tagged in today’s indictments are accused of conspiring to submit more than $50 million in false claims to the Medicare program.

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