Tag Archives: task force

The Biggest Medicare Fraud Cases of 2015

Medicare does not keep records of how much it loses annually because of fraud, but the FBI, which oversees the investigation and prosecution of those alleged to have participated in fraud, estimates that 3% to 10% of all Medicare billings are fraudulent. The FBI task force believes that healthcare fraud costs taxpayers “tens of billions of dollars a year.”

Here is an overview of some of the biggest Medicare fraud cases of 2015:

  1. In June 2015, 243 healthcare providers across the country were charged individually with Medicare fraud. This was the largest-ever coordinated takedown in the history of the National Medicare Fraud Strike Force history. Doctors, nurses, pharmacists, home health workers and other healthcare professionals were all indicted for falsely billing Medicare for approximately $712 million in various fraudulent schemes. The healthcare providers allegedly:
  • Billed for services that were not rendered
  • Charged for equipment that was never delivered
  • Billed for care that was not needed

Specific criminal charges include:

  • Conspiracy to commit healthcare fraud
  • Violating anti-kickback statutes
  • Money laundering
  • Identity theft

Healthcare providers nationally were included in the sweep of the task force. Charges were brought in Texas, Louisiana, Florida, California, New York and elsewhere. The defendants face years in prison in addition to having their assets forfeited to the government and having to repay the amount of money they fraudulently obtained.

In a press release announcing the takedown, the attorney general for the U.S. expressed the commitment of the Department of Justice to continue its “focus on preventing wrongdoing and prosecuting those whose criminal activity drives up medical costs and jeopardizes a system that our citizens trust with their lives.”

  1. Also in June 2015, the former president of a Houston hospital was sentenced to more than 40 years in federal prison and ordered to pay $46.8 million in restitution to Medicare. His son and two other co-conspirators were also found guilty of receiving kickbacks, conspiracy to commit Medicare fraud and money laundering. The scheme involved billing Medicare for psychiatric services that were never provided to patients. The total amount of money fraudulently received by all participants was estimated to equal $158 million.
  1. In October 2015, Millennium Health in Boston, formerly Millennium Laboratories, admitted to billing Medicare and other governmental healthcare programs more than $256 million for laboratory tests that were either unnecessary or never actually performed. The lab also provided kickbacks to physicians for referring patients for testing. Millennium, with headquarters in San Diego, is one of the largest urine-testing laboratories in the U.S. According to the Massachusetts U.S. attorney, “Millennium promoted indiscriminate and unnecessary testing that increased medical costs without serving patients’ real medical needs. A laboratory which knowingly conducts medically unnecessary testing operates unlawfully and squanders our precious federal health care resources.”
  1. In August 2015, a New York man who operated several healthcare clinics for treating HIV/AIDS patients was sentenced to more than seven years in federal prison for defrauding Medicare out of more than $31 million. He billed for treatment that patients did not need and often were not given. Medicare was billed for infusion or IV treatment for many patients who never received treatment. Some patients who were provided infusion therapy were administered doses that were highly diluted.
  1. Two psychologists were recently added to an indictment to join two of their cohorts who had previously been charged with defrauding Medicare of more than $25 million. The psychologists are owners of two companies that provide psychological testing to nursing home patients in four Gulf Coast states: Alabama, Florida, Louisiana and Mississippi. The problem is that the psychologists allegedly billed Medicare for tests that were not medically necessary and, in many cases, were never performed. The case is pending, and the press release notes that the defendants are presumed innocent until proven guilty.

The Medicare Fraud Strike Force, since its formation in March 2007, has charged 2,300 defendants with fraudulently billing more than a total of $7 billion. The task force is committed to continuing its work to hold providers accountable so that the number of fraudulent providers will decrease.

The Mental Health Disorder Employers Need to Recognize

As many employers offer wellness programs, they focus on increasing their employees’ physical health but often neglect to offer any mental health component to their wellness programs. If employers do offer a mental health component to their wellness programs, the focus is usually on depression, the most common mental health issue. Yet, there is a prevalent mental health disorder that affects 30 million Americans and often goes untreated – eating disorders.

Employers that provide incentives for weight loss programs without a mental health component are putting themselves at risk by not being able to detect employees who develop unhealthy eating and exercise habits.

Twenty million women and 10 million men will be affected by an eating disorder at some point in their lifetime, according to the National Eating Disorder Association (NEDA).  Research shows that 35% of normal dieters progress to pathological dieting and, of those, 20% to 25% develop partial or full eating disorders.

There is a common misperception that eating disorders are simply an obsession with eating or dieting. Eating disorders are serious mental health disorders that have the highest mortality rate of any mental health disorder. Individuals with anorexia nervosa are eight times more likely to attempt suicide than the general population, and suicide is the leading cause of death for those with this disorder. Eating disorders also often occur along with other mental illnesses, and approximately 50% to 75% of those with an eating disorder also suffer from major depressive disorder. However, because of the stigma surrounding eating disorders and mental health, only one in 10 will seek treatment.

Mental health disorders, such as eating disorders, need to be viewed and treated like physical illnesses. As with most illnesses, early intervention and detection are the keys to recovery.

How Employers Can Help

  1. Learn the signs and symptoms of eating disorders:
  • Constant adherence to increasingly strict diets, regardless of weight
  • Habitual trips to the bathroom immediately after eating
  • Secretly bingeing on large amounts of food
  • Hoarding large amounts of food
  • Exercising compulsively, often several hours per day
  • Avoidance of meals or situations where food may be present
  • Preoccupation with weight, body size and shape, or specific aspects of one’s appearance
  • Obsessing over calorie intake and calories burned via exercise, even as one may be losing significant amounts of weight

The National Eating Disorder Association provides more information on the types of eating disorders and signs and symptoms. 

Learn the signs and symptoms of suicide:

  • Talking about wanting to die or to kill themselves
  • Talking about feeling hopeless or having no reason to live
  • Talking about feeling trapped or in unbearable pain
  • Talking about being a burden to others
  • Increasing the use of alcohol or drugs
  • Acting anxious or agitated; behaving recklessly
  • Withdrawing or isolating themselves
  • Showing rage or talking about seeking revenge
  • Displaying extreme mood swings

Stopasuicide.org provides more information on the signs and symptoms of suicide and how to help.

Provide employees tools to check in on their mental health:

  • Online screenings are a great first step toward treatment and offer employees an anonymous, confidential way to learn if they have signs or symptoms of an eating disorder or other mental health disorder.
  •  Online screenings consist of a series of questions designed to indicate whether symptoms of an eating disorder are present. The screenings also includes a question about suicide. If an individual provides a positive answer during this question, a pop-up message appears that provides the individual with emergency resources such as 911 or the National Suicide Prevention Helpline, if needed.
  • After completing the screening, participants receive immediate feedback and referral information to local resources for further information or treatment.

Connect with resources

  • The Workplace Task Force, a component of the National Action Alliance for Suicide Prevention, provides support for employers and works with them to implement a comprehensive, public health approach to employee wellness.

The best way to address employee mental health is to ensure it is a key component of any employee wellness program. In addition, employers that publicly show a commitment to employee mental health help to reduce the stigma surrounding mental health disorders and increase help-seeking among those suffering.

National Eating Disorder Awareness Week is Feb, 22-28, providing employers with a great opportunity to increase awareness of eating disorders among their employees. Screening for Mental Health in partnership with the National Eating Disorder Association provides anonymous online mental health screenings at http://mybodyscreening.org/.