Medicare fraud: What you need to know

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 Updated:

Health and Human Services Secretary Kathleen Sebelius speaks during a news conference at the Justice Department to announce a Medicare Fraud Strike Force crackdown on unrelated scams that allegedly bilked the taxpayer-funded program of $452 million — the highest dollar amount in a single Medicare bust in U.S. history. Attorney General Eric Holder is at right. 

Haraz N. Ghanbari/AP

Since 2010, our Manipulating Medicare series has taken a hard look at the problems plaguing one of the nation’s most expensive public programs. This year's investigative pieces from iWatch News will look at questionable billing practices and political interference that directs Medicare spending in often-inefficient ways.

The big story in Medicare fraud last week was an unprecedented bust of 107 doctors, nurses and social workers who allegedly billed $452 million of fraudulent medical expenses to the taxpayer-funded program, as reported by the Associated Press. Though the crackdown was huge, Medicare fraud is believed to cost up to $90 billion annually, the scams associated with the recent arrests only represent a fraction of the overall problem.

Brief history:

Back in March 2007, agencies within the Department of Justice teamed up with the Department of Health and Human Services to create a Medicare Fraud Strike Force. It is a collaboration that became part of a larger initiative known as the Health Care Fraud Prevention and Enforcement Action Team (H.E.A.T.) in 2009. Now with about two-dozen prosecutors in nine U.S. cities, the strike force has busted more than 1,300 people accused of billing the Medicare program for at least $4 billion (during FY2011 alone) in medical services that never happened.

Places to learn more:

  • “Medicare fraud rampant in South Florida”, by The Miami HeraldAugust 3, 2008
  • “111 charged with Medicare fraud in 9 cities” by The Washington TimesFebruary 17, 2011
  • “Feds Fight Rampant Medicare Fraud in South Florida” by NPR’s "All Things Considered", November 6, 2007
  • “Senior-citizen volunteers fighting Medicare fraud” by the Associated Press, December 29, 2009
    “52 arrested in sweeping Medicare fraud case” by The Los Angeles TimesOctober 14, 2010
  • “Rockwall doctor accused of fraud has long history of patient harm” by The Dallas Morning News [PAYWALL], February 28, 2012

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