FBI gains $1.2B in healthcare fraud restitution

There's no rest for the wicked. The FBI reported on Monday that its crackdown on healthcare fraud led to $1.2 billion in restitution last year.

In 2011, the FBI investigated 2,690 cases, which led to 1,676 informations/indictments and 736 convictions. Some of the most common reasons were billing for services not provided, duplicate claims, medically unnecessary services, upcoding of services or equipment and kickbacks for referring patients for services paid for by Medicare and Medicaid.

"We've seen increasing involvement of organized criminal groups in many of these schemes," the FBI said in an announcement yesterday.

Fraudulent billings, both public and private, are estimated between 3 and 10 percent of total healthcare expenditures.

Although the government focused on certain cities last year where schemes often occur, the FBI cautioned that the schemes can happen anywhere in the country, targeting large healthcare programs, public and private, as well as beneficiaries.

"All health care programs are subject to fraud; however, Medicare and Medicaid programs are the most visible," the FBI said in the report.

Particular areas of concern include durable medical equipment; hospital fraud; physician fraud; home health agencies; beneficiary-sharing; chiropractic, pain management and associated drug diversion; physical therapists; prescription drugs; multidisciplinary fraud; and identity theft, which involve physician identifiers used to fraudulently bill government and private insurance programs.

Meanwhile, actor Michael Douglas whose role in "Wall Street" popularized the catch phrase, "Greed is good," issued a public service announcement for the FBI. Douglas--who said that people would high-five him for his role as inside trader, Gordon Gekko--said the culture has to change, Bloomberg reported.

For more information:
- read the AP article
- see the FBI press release
- check out the report
- here's the Bloomberg article
- watch the public service announcement

Related Articles:
Medicare fraud detection system disappoints
DoJ, HHS boasts record year in $4.1B healthcare fraud recovery
Healthcare fraud stats continue to rise
Feds' $5.6B fraud collection hits record high

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