Prosecution of health care fraud on the rise, feds say
No, it’s not your imagination. The federal effort to investigate and prosecute health care fraud has tripled in the past four years.
The number of health care-related investigations by the Federal Bureau of Investigation in Washington, DC, tripled between 1992 and 1996, when there were 2,200 cases. During the same time period, criminal prosecutions increased from 83 to 246 cases, and the number of convictions rose from 90 to 307. Civil health fraud cases rose even more dramatically, a ninefold increase from 270 in 1992 to 2,488 in 1996.
U. S. Attorney General Janet Reno announced the figures recently and said the Justice Depart-ment considered health care fraud "the crime of the 90s." Fraud could account for as much as 10% of all U.S. health care spending, or $100 billion a year, according to a report from the federal General Accounting Office. Reno confirmed that investigators are targeting laboratories, home care companies, physicians, and hospitals.
At about the same time as Reno’s announcement, the huge Blue Cross and Blue Shield health groups announced they are stepping up their own fight against health care fraud. The fraud unit of Blue Cross and Blue Shield of Michigan saved or recovered more than $20 million last year, according to plan executives speaking at a meeting in Washington, DC. Forty-seven other Blues plans also have instituted a dedicated antifraud program. Most fraud investigations are triggered by a call to the Michigan Blues’ toll-free antifraud hotline, and many calls are prompted by the routine mailings of "explanation of benefits" forms to customers.
Twelve employees of Mederi of Dade County (FL) recently were charged with health care fraud, including two former administrators and five physicians. The administrators were accused of creating a network of phony nursing home groups and using the network to submit bills to Medicare for services that were not needed, not provided, or both. The indictment includes 102 counts of fraud, conspiracy, and money laundering involving $15 million in Medicare billings.
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