Michigan sees results from greater focus on fraud prevention

The Western District of Michigan is seeing "unprecedented" levels of fraud recovery in the form of civil settlements, convictions, and decreased expenditures within the home health sector, according to a release from Patrick Miles Jr., United States Attorney for the Grand Rapids-based district.

Miles says that additional resources devoted to healthcare fraud investigations and litigation has led to 20 criminal convictions, $5.5 million in settlements, and a savings of $100 million in Medicare home health expenditures in the last two years. He credits this recent success to ongoing partnerships with the Drug Enforcement Agency (DEA), the FBI, and the Department of Health and Human Services Office of Inspector General (OIG), along with outreach efforts aimed at provider organizations within the state.

Some notable cases over the past two years include a $4.4 million settlement with Portage Hospital related to unnecessary physical therapy services, and criminal convictions of six pharmacists and the CEO of Kentwood Pharmacy for a scheme that cost Medicare $80 million. Miles also pointed to unnecessary laboratory testing and improper relationships between labs and physicians as key focus areas for fraud investigators.

According to an article by MLive.com, this spike in prosecutions is also due to a renewed effort by the government to prosecute fraudsters in both civil and criminal proceedings. Miles also told MLive.com that these prosecutions have deterred future fraud schemes, although authorities are still concerned about rising pharmacy costs, kickbacks to home health agencies, and the number of physicians that prescribe controlled substances.

A state auditor report released last year indicated that the Michigan Medicaid Home Help Program paid $160 million in improper payments over 29 months in order to keep patients out of costly care settings. Additionally, according to a December USA Today report, Michigan spends as much on home health visits as 42 other states combined.  

For more:
- here's the U.S. Attorney's release
- read the MLive.com story

Suggested Articles

The HHS OIG is asking for an additional $23.7 million to support fraud oversight that has benefited from an emphasis on data analytics.

A New York surgeon was sentenced to 13 years in prison for fraud and more physician practice news from around the web.

A federal judge has ruled that the U.S. government’s remaining fraud case against UnitedHealth can move forward.