THE MANY AND GROWING FORMS OF HEALTH CARE FRAUD

The annual estimate of annual health care fraud in the U.S. is $80 billion and some think it is twice that amount. The Inspector General’s Office at Health and Human Services reports that the types of fraud are becoming more diverse. Some bill Medicare for physical therapy, electronic stimulation treatment, chiropractic services, laser surgeries and were also offering patients massages, facials, lunches and dancing classes. These were unnecessary services which are not covered by Medicare but hidden in other bills which are covered. In a report issued to Congress in march the Medicare Payment Advisory Commission said high payments in the home health care arena may also encourage the entry of marginal or fraudulent providers who are motivated by the financial returns by excessive payments. In February, authories uncovered what they said was the largest health care fraud scheme in our history. The Medistat Group Associates were arrested in Dallas on charges of participating in nearly $375 million health care fraud scheme. According to allegations there were cash payments in exchange for ensuring documents containing signatures of physicians and giving Medicare beneficiaries cash and groceries to get them to signup for home health care services and paying recruiters $50 for bringing homeless beneficiaries to a defendant’s car for treatment while parked outside the homeless shelter.Under the Centers for Medicare and Medicaid Systems, home health services are billed under Part A, physician services are billed under Part B and equipment claims are billed under yet a different part of the program. In past years, Cantrell says, keeping track of those payments was done in separate places, which made the task of keeping up with the fraudsters that much harder.