Medicare Compliance & Reimbursement

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Feds Bust Organized Crime Medicare Fraud Scheme

The feds have taken down one of the huge Medicare fraud schemes of the type that is making your life harder. Law- and policy-makers have been issuing new compliance rules based on the crimes like those allegedly committed by an Armenian -- American organized crime syndicate. Seventy-three defendants in that case were charged in indictments unsealed Oct. 13 in five judicial districts with various health care fraud-related crimes involving more than $163 million in fraudulent billing, says the Department of Justice, FBI, and OIG in a release.

The defendants allegedly stole the identities of doctors and thousands of Medicare beneficiaries and operated at least 118 different phony clinics in 25 states, the release says. The criminal operation is "the largest Medicare fraud scheme ever perpetrated by a single criminal enterprise and charged by the Department of Justice."

"The emergence of international organized crime in domestic health care fraud schemes signals a dangerous expansion that poses a serious threat," says Acting Deputy Attorney General Gary G. Grinder "These syndicates are willing to exploit almost any program, business or individual to earn an illegal profit."

Fifty-two arrests for the fraud scheme occurred in five states -- California, Georgia, New Mexico, New York, and Ohio, the DOJ says. "We want to restore the confidence in the nation's healthcare system and assure practitioners we will not stand by and let their identities be used for criminal gain," Kevin Perkins, FBI Assistant Director of the Criminal Investigative Division, says in the release.

"Criminals stealing from Medicare needn't look over their shoulders to know that we are in hot pursuit," adds HHS Inspector General Daniel R. Levinson.

In addition to healthcare fraud, the defendants face charges for racketeering, identify theft, bank fraud, money laundering, and other crimes.

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