Inspector General details anatomy of a fraud bust

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Collaboration between authorities is the reason that the Office of Inspector General, the Centers for Medicare & Medicaid Services and the Department of Justice managed to set a record-breaking year in 2011. The result: criminal healthcare fraud charges against 1,430 defendants, leading to 743 criminal convictions, 977 new investigations of civil healthcare fraud and recoveries of about $4.1 billion.  

In September 2011, the U.S. Department of Health & Human Services and the Justice Department indicted 91 defendants, including physicians, nurses and other medical professionals, for their role in Medicare billing fraud, worth $295 million--the largest sum of its kind in Medicare's Strike Force history. Last week, Inspector General Daniel Levinson detailed how authorities nabbed the fraudsters. Levinson pointed to the ABC Home Health/Florida Home Health case, in which more than 50 individuals were convicted in bilking Medicare out of $25 million for home health services and physician therapy that weren't medically necessary or not provided. OIG and CMS therefore worked together to guard against similar schemes. Testimony (.pdf)