Home Health & Hospice Week

The fact that federal fraud fighters recover $4 billion a year in false claims sounds pretty impressive -- until you consider that Medicare and Medicaid fraudsters rake in an estimated $60 billion a year.

Big potential profits are why organized crime is moving in on health care, explained Health and Human Services Deputy Inspector General Tim Menke in a recent NPR interview with Scott Simon.

Criminals see health care fraud as "lucrative" and "safe," according to Menke. "Why rob a bank and risk getting shot when you can click a mouse and bill Medicare or Medicaid, basically lie on some forms, and make millions of dollars doing so?" he said.

When Simon asked if health care fraud attracts "Tony Soprano" types, Menke countered that it's not just stereotypical Italian mobsters getting in on the act -- but Armenians, Cubans, Nigerians, Russians,Ukrainians, "you name it across the board. And what's disturbing now is we're seeing a viral nature of health care fraud going across the United States where some of these groups are actually merging."

Menke talked up HHS' HEAT data analysis initiative. Health care fraud fighting is a different ball game from the old white collar crime days, he stressed. "Historically, we've taken boxes of paper in a typical fraud investigation. Now, because of the organized crime and street gang influence, we're taking machine guns, automatic weapons out of facilities that are engaged in health fraud."