Regular readers of Alltimecrime.com know that fixing the badly flawed Medicare program and putting Medicare fraudsters out of business is a major priority of the website.
Fortunately, we have many friends who feel the same way. One of them is U.S. Attorney for the Western District of Michigan Patrick Miles Jr., whose aggressive approach to fighting health care fraud has achieved impressive results.
Miles said his office pursues criminal charges, civil penalties and administrative exclusions in health care fraud cases, and educates health care providers and the public about detecting and avoiding health care fraud practices.
Prosecutions and civil remedies
“We made addressing financial frauds, such as a health care fraud, one of our top priorities,” he said. “We put additional resources into prosecuting health care fraud cases and warning practitioners of our emphasis on pursuing both health care fraud prosecutions and civil remedies. We hold corporations and individuals accountable for wrongdoing. Consequently, we are seeing very positive results.”
Miles’ office has obtained 20 criminal convictions in cases involving health care fraud or health care practitioners over the past two years and has negotiated more than $5.5 million in civil health care fraud settlements.
Special attention has been giving to home health care and home health care kickback payments.
Miles said that many health care frauds involve unnecessary procedures and tests. “Law enforcement and our office continue to focus on unnecessary laboratory testing, including unnecessary blood, urine, and drug testing. We will also address improper relationships between practitioners and laboratory testing companies,” he said.
It is illegal to offer or request, or pay or receive, money or anything of value in exchange for referring Medicare and Medicaid patients for health care services.
Patients and health care consumers can help stop frauds by looking out for the following danger signs:
• Check for services and procedures not rendered.
• Cost of procedures disproportionate with time or complexity.
Waivers of Co-Payments:
• Blanket waivers of co-pays are generally not permitted.
• Waivers are a good indication of fraud schemes because if patients are not paying, they are unlikely to scrutinize insurance billings.
To report any kind of health care fraud, call 1-800-HHS-TIPS.