Over the last few weeks, more than 20 people have been arrested for taking part in a scam that involved defrauding the U.S. Medicare system.

What is Medicare?

Medicare is a health insurance program administered by the US government under the Social Security Act of 1965. This program is for people who are 65 years old or who meet special criteria. Between 42 million and 45 million Americans use Medicare making it the largest single payer of healthcare in the nation.[1] The program is partially funded by payroll taxes.

The Problem

While helping millions, Medicare provides criminals the ability to steal a sizable chunk of the half trillion dollars paid out each year in Medicare benefits.” As CBS 60 minutes recently reported, “Medicare fraud - estimated now to total about $60 billion a year - has become one of, if not the most profitable, crimes in America.”[2]

Solving the Problem

As President Obama pursues health care reform, the government is cracking down on Medicare fraud. The Obama administration gave Medicare an additional $200 million to fight fraud as part of its stimulus package. Billions of dollars were given to computerize medical records and upgrade networks, helping Medicare catch more fake charges and schemes.

A Medicare fraud strike force was created and launched in 2007. Since then, more than 331 people across the nation have been charged with Medicaid fraud.

The most recent arrests were the fourth major sweep and involved fraudulent charges to Medicare for expensive medical equipment such as wheelchairs and hospital beds when they weren’t needed. Wheelchairs were ordered for people who didn’t need them, never received them, and even to people who were already dead.

The New Criminals

Healthcare fraud has become an entire industry: Recruiting patients, finding patient lists, linking in doctors, and thinking up new scams. Entire groups are dedicated to nothing but finding better ways to steal from Medicare.

Also, the players have changed. Medicare fraud was once a white-collar crime; the newest scammers are criminals, even gang-members. The current law allows criminals with violent records, including convicted murderers, to obtain Medicare supplier licenses. An applicant can only be rejected if a felony conviction occurred less than 10 years ago.

In South Florida, Medicare fraud has become a bigger criminal enterprise than cocaine. This creates even more problems, including the use of more violence in these schemes.

How Could this Happen?

The Centers for Medicare and Medicaid Services is blamed for their lack of oversight in the program that is supposed to care for senior citizens. However, Obama vowed to fix the problems in the system through agents and using funds recovered from these busts to help support the initiatives.

As healthcare becomes the nation’s biggest concern, the system is receiving more attention, which in turn helps with the discovery of flaws and scams. As President Obama warned, “rising costs are driving huge federal budget deficits that imperil our future,” but, he explains, “There is enough waste and fraud in the system to pay for health care reform if it was eliminated.”[3]

Question For Your Attorney

  • How do I apply for Medicare?
  • What should I do if I believe someone is committing Medicare fraud?
  • What if my information was used in a Medicare scam, unbeknownst to me? What can I do?

Tagged as: Insurance, Medicare and Medicaid, medicare fraud, medicare medicaid lawyer