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Health care fraud is a big and sleazy business

McClatchy-Tribune News Service

Posted: 4:00am on May 9, 2012; Modified: 8:17am on May 9, 2012

The following editorial appeared in the St. Louis Post-Dispatch on
Tuesday, May 8:

News coverage of last week's simultaneous arrests of 107 people in
seven cities for alleged health-care fraud pretty much appeared and
disappeared in a day, at least outside Miami, Baton Rouge, Houston,
Los Angeles, Detroit, Tampa and Chicago, the cities involved.

Behind the headlines, however, is a little-noticed law enforcement
program that has focused exclusively on health-care fraud, waste and
abuse for 15 years. Given the fashionable reflex to blame government
for everything, it's worth taking special note of a joint federal,
state and local collaboration that so far has recovered and returned
more than $20 billion of taxpayer money to the Medicare Trust Funds,
and additional funds to other health care programs.

The indictments underpinning last week's operation by multiple
federal, state and local agencies allege some $450 million in false
Medicare billings, more than any other single enforcement action to
date.

In addition to handling the arrests, more than 500 agents of a special
Medicare Fraud Strike Force also suspended the Medicare participation
rights of 52 health care providers and executed an additional 20
search warrants connected with other ongoing investigations.

The strike force, which is jointly supervised by the U.S. Departments
of Justice and Health & Human Services, operates through the authority
of the Health Care Fraud and Abuse Control Program originally created
by Congress in the Health Insurance Portability and Accountability Act
of 1996.

According to a description released by HHS, the charges against those
arrested in last week's seven-city operation were based on "a variety
of alleged fraud schemes involving various medical treatments and
services such as home health care, mental health services,
psychotherapy, physical and occupational therapy, durable medical
equipment and ambulance services."

There were bills submitted for medical services that weren't needed
and bills for services that were never provided, as well as kickbacks
paid for Medicare beneficiary information used in submitting the
bills.

Those arrested deserve fair trials and, if convicted, license
revocations and prison time.

Contrary to the tired racial and class stereotypes of high-living
welfare queens and other supposed cheats, health care fraud strike
force investigators - working in the real world - find large-scale
fraud where the large-scale money is: on the provider side, not the
consumer side.

Last week's indictments and supporting court documents named owners of
health care companies and ambulance companies, doctors, nurses,
licensed social workers, physical and psychological therapists and a
pharmacist.

The annual report on the Health Care Fraud and Abuse Control Program,
released in February, charted some $4.1 billion collected through
criminal and civil enforcement actions and deposited in the Medicare
Trust Funds and the U.S. Treasury and transferred to other federal
agencies involved in health care programs. Not included are funds
returned to states for fraud involving Medicaid.

At 17 percent of America's gross domestic product, health care is as
big and complex a business as there is, and most of its constituent
parts operate honestly. But there's so much money in play that would-
be criminals seem endlessly creative and resourceful. Estimates of the
annual cost of health care fraud range from $60 billion to $90
billion.

The enforcement work of the Health Care Fraud and Abuse Control
Program has returned an average of $5.10 for every $1 spent since
1997, and the ratio has increased in recent years. Those are rich
dividends.

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