Medicare fraud fighters deliver healthy ROI

The Medicare Fraud Strike Force set new records for prosecutions in fiscal year 2013, having filed 137 cases, charged 345 people, and obtained 234 guilty pleas and 46 jury trial convictions, the U.S. Department of Justice announced this week.

Moreover, recent reports indicate that for every dollar the DOJ and the U.S. Department of Health and Human Services spent fighting fraud, they returned an average of $8 to the government.

These results speak not only to the success of federal anti-fraud watchdogs, but also to the extent of the crime keeping them busy in nine cities deemed fraud hotbeds: Baton Rouge, La.; Brooklyn, N.Y.; Chicago; Dallas; Detroit; Houston; Los Angeles; Miami; and Tampa, Fla.

"The Medicare Fraud strike force is one of the country's most productive investments," Acting Assistant Attorney General Mythili Raman of the DOJ's criminal division said in the announcement. "We are not only putting hundreds of criminals who steal from Medicare in prison, but also stopping their theft in its tracks, recovering millions of dollars for taxpayers, and deterring potential criminals who ultimately decide crime isn't worth it."

Case in point: The Medicare Fraud Strike Force targeted Pavel Zborovskiy, who pleaded guilty Tuesday to conspiracy to pay and receive kickbacks linked with a $13 million fraud and money laundering scheme, the DOJ announced. The patient recruiter faces a maximum of five years in prison and a fine of more than $2.5 million. Zborovskiy recruited beneficiaries to visit a Brooklyn clinic and gave them illegal cash kickbacks to receive unnecessary healthcare services for which Medicare and Medicaid paid more than $13 million.

The high number of federal healthcare fraud cases came in conjunction with a banner year for civil fraud recoveries, as FierceHealthPayer reported: The DOJ recouped $3.8 billion in civil fraud cases in fiscal year 2013. And governmental anti-fraud efforts have been consistently productive, with the Medicare Strike Force charging more than 1,700 defendants since 2007, according to the DOJ.

For more:
- read the DOJ announcements on the Strike Force and Zborovskiy case

Suggested Articles

Drugs used for ventilator patients—such as sedatives and neuromuscular blockers—are running low.

Express Scripts saved its plan sponsors $4.3 billion last year through its slate of SafeGuardRx value-based care programs.

The COVID-19 pandemic is widening disparities in medication adherence between patient populations, which could have major health implications.