HEALTH CARE FRAUD SUPPRESSION INVESTIGATIONS

 Health Care Fraud Suppression Investigations

 

In June, a 20-year-old man was arrested for Medicare fraud in western Pennsylvania for allegedly having false medical records and prescriptions filled by more than 30 different doctors. The indictment says the fraudulent scheme began in 2011.

They have medical records to be able to get free procedures. They have scripts to be able to get paid for the procedures that are supposedly had,- U.S. Attorney David Freed said.

In nearby Allegheny County, authorities say 23 people were indicted on health care fraud charges in connection with a doctor’s office. The doctors are charged with signing false paperwork to obtain more than $5 million in fraudulent payments.

So far, two doctors and four nurses have pleaded guilty.

We’re going to continue to attack this problem until we get this under control. And we’re going to use all the tools in our arsenal to get it under control,- Freed said.

Fake Doctor Nabbed In Florida

Meanwhile, authorities in Florida arrested a 52-year-old woman they say posed as a doctor. She had been licensed to practice in Massachusetts and New York.

U.S. prosecutors say she provided services that were “not authorized by a physician.”

The claims she made, she was untrained, she did not know what to do. Some of it was high-tech treatments like deep tissue massage, which we never see in a typical doctor’s office,- said Special Agent Jose Caraballo, with the Florida Department of Law Enforcement.

The FDA says nearly 20 percent of doctors accused of fraud have been charged with health care fraud.

We’re going to be attacking it on multiple fronts: state, federal and international,- Freed said.

Health Care Fraud Information

The Department of Health and Human Services says federal agencies are aware of more than $100 billion in fraud in 2015.

That’s an amount that authorities say is in the billions of dollars.

The FBI says when doctors are convicted of fraud, the crime often leads to long prison sentences and financial penalties.

So as soon as there’s a conviction of a health care fraud, that’s also the end of the fraudulent provider,- Caraballo said.

The FBI warns health care fraud is a crime that can get your insurance canceled, destroy your credit and even get you deported.

Other health care fraud-related news:

The latest federal statistics show that $700 million in health care fraud was reported in 2014.

To report health care fraud, go to the Health Care Fraud Hotline. The number to call is 1-866-HHS-TIPS.

Also, you can report health care fraud to the Attorney General’s Office in your state.

Some additional health care fraud tips from the FBI:

Do your homework. To investigate the doctors and other medical care suppliers.

Get the forms or documentation you’ll need in advance.

Ask specific questions about the procedure.

Read the statements the provider is going to give you. If there are too many health benefits, it might be a red flag.

Report health care fraud to your insurance company. If you file a complaint about a health care provider, they’ll also have to report it.

Health Care Fraud Facts

Health care fraud refers to health care fraud offenses — not just those involving health care providers. The term health care fraud includes any offense, conductor, scheme, or another scheme, intended to procure, exploit or obtain money or property by any means involving health care by any means.

Federal health care fraud laws address serious federal crimes in which health care fraud is proven beyond a reasonable doubt.

Health care fraud offenders will be charged with health care fraud offenses in federal courts when federal courts identify health care fraud as a significant and ongoing health care fraud problem.

Prison sentences can range from a few months to more than 10 years in prison, plus fines.

Jail sentences will be served by federal prisoners.

When someone is convicted of health care fraud, they also face possible restrictions on their future employment as a health care provider, pharmacy technician, or related field.