Wednesday, April 2, 2014

Medicare Fraud: Who’s in on it and how they’re getting away with it

Mark Mandell, Esq.

Imagine a single mom with five kids with no income on record and struggling to make ends meet – sounds like an eligible candidate for government subsidy programs. She signs up for the SNAP (Supplemental Nutrition Assistance Program) and Medicaid for herself and her children and gets government assistance to help cover her rent.

But in reality, she’s married, her husband has an all-cash business, which allows her to rake in thousands of dollars a month via welfare programs and remain undetected by the government.

This situation is all too common throughout the US. Savvy individuals are able to game the healthcare system through tricks such as getting married under religious law but not state law. These individuals scam taxpayers time and time again.

The amount of taxpayer money down the drain from fraud and spent on curbing fraud are jaw-dropping.

The federal government is projected to lose $19.6 billion in “improper payments” under the Medicaid program. Accurate fraud figures can be hard to calculate since improper payments aren’t necessarily fraudulent--they could be due to an error either by the government or recipient. Fraud estimates for fiscal year 2014 are up from last year’s $17.4 billion, but down from 2010’s $22.5 billion estimation of improper payments.

Federal Medicaid Spending is projected to be $298 billion in 2014, and Medicare is projected to be $603 billion. The SNAP program cost $79.9 billion in 2013. The White House requested $389 million to fund the Department of Health and Human Services’ Office of the Inspector General in an attempt to better curb waste in the 2104 budget.

In February of this year, the D.C. U.S. attorney’s office announced the largest health-care fraud takedown in the history of the District. The multi-year effort led to more than 20 arrests and schemes involving millions of dollars in fraud, kickbacks and false billings in the home health-care services field throughout the nation’s capital.

Ron Machen was the U.S. attorney for Washington, D.C. on the case. He said his office was tipped off to the scheme when certain agencies were requesting 300% more than other Medicaid beneficiaries over the past several years.

“We were wondering what the reason was for such a skyrocket in growth,” Machen says in a recent Fox News report. “We used wires, cover agents and beneficiaries to uncover them.”

What they uncovered was eye opening. The investigation busted personal care assistants misrepresenting the amount of time they spent with beneficiaries. These beneficiaries would fill out inaccurate time sheets and submit them to home care agencies. While the sheets listed them as being seen by assistants for up to eight hours, in reality the personal care assistants never saw the patients.

The beneficiaries were elderly, disabled and low-income, said Machen, and recruiters would offer them kickbacks of $200 a week and coach the patients on what to say if someone asked about their work.

Healthcare fraud is also an increasing concern with the Obamacare overhaul.

If you have questions about health care fraud, or are afraid that you may have been the victim of a fraud, contact the experienced attorneys at Fausone Bohn, LLP, by calling (248) 380-0000 or online at

To read the Fox News story on this fraud bust, click here:

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