FBI - Medicare Fraud

[E2014T]

The overwhelming majority of people who go into the health care industry do it because they want to help people. Unfortunately, there are also some unscrupulous individuals who do it because they think they can take advantage of the health care system for their own financial gain.

That’s just what happened in the case of an Oklahoma hospice executive. Paula Kluding, owner of Prairie View Hospice, Inc., located in Chandler, Oklahoma, submitted millions of dollars’ worth of fraudulent claims to the federal Medicare program. But after a thorough investigation by the FBI and our partners at the U.S. Department of Health and Human Services’ Office of Inspector General, Kluding was convicted of Medicare fraud and other related charges at trial and was recently sentenced to a federal prison term. She was also ordered to pay $2.5 million in restitution to Medicare.

https://www.fbi.gov/news/news_blog/medicare-fraud

[ribshaw]

Some rather disturbing reading on the subject.


A total of 243 people were arrested and charged with stealing $712 million from Medicare. The arrests included 46 doctors, nurses, pharmacy owners, and other medical professionals. Facilities billed the federal government for therapy sessions where patients were actually just moved, never treated. In a particularly disturbing case, a Michigan doctor allegedly “prescribed unnecessary narcotics in exchange for patients' identification information, which was used to generate false billings.

$712 Medicare Fraud Bust: The Real Threat Is Doctors, Not 'Welfare Queens' - The Atlantic (http://www.theatlantic.com/national/archive/2015/06/this-is-what-government-fraud-looks-like/396317/)

To round out the picture, you can toss in defense contractor fraud -- perhaps as much as another $100 billion per year, roughly in the same range as Medicare and Medicaid combined. All told, fraud in federal programs may come to $300 billion a year or about 10 percent of the budget (as with financial services). Just How Wrong Is Conventional Wisdom About Government Fraud? - The Atlantic (http://www.theatlantic.com/politics/archive/2013/08/just-how-wrong-is-conventional-wisdom-about-government-fraud/278690/)


Government Programs Have Become One Big Scammer Fraud Fest (http://www.forbes.com/sites/merrillmatthews/2014/01/13/government-programs-have-become-one-big-scammer-fraud-fest/)

Not much has changed since this came out...

U.S. GAO - Fraud in Government Programs: How Extensive Is It and How Can It Be Controlled (Volume II) (http://www.gao.gov/products/AFMD-81-73)

[E2014T]

Not much has changed since this came out...

U.S. GAO - Fraud in Government Programs: How Extensive Is It and How Can It Be Controlled (Volume II) (http://www.gao.gov/products/AFMD-81-73)
Something did change: the reports and strategies to combat fraud use better graphics and font in 2015 :RpS_smile:

http://www.gao.gov/products/GAO-15-593SP

[ribshaw]

The foreign-enrollment dodge is a new twist on Medicare fraud, which costs American taxpayers billions of dollars a year, according to FBI estimates.

Medicare Fraud Is Committed Well Beyond U.S. Borders - Bloomberg Business (http://www.bloomberg.com/news/articles/2015-08-20/medicare-fraud-is-committed-well-beyond-u-s-borders)