Law-enforcement officials estimate that fraud accounts for as much as 10 percent of Medicare’s yearly spending, which amounts to $58 billion in bogus payments in the 2013 fiscal year, reports the Wall Street Jurnal. The U.S. government recovered just $2.86 billion in Medicare funds that year. “Usually the money gets away,” said Glenn Ferry, who oversees the Department of Health and Human Services Office of Inspector General’s strike-force operations in Los Angeles. “As soon as it hits an account, it disappears.”
Many strike-force investigations start with an agent behind a computer screen, eyeing page after page of Medicare claims data, looking for unusual billing patterns. In April, the government released data on doctor billing for the first time after a legal effort by the Journal to make the information public. In one case detailed by the newspaper, federal prosecutors alleged that a fraud stretched over eight years and involved prescribing patients equipment and hospice and home-health services they didn’t need, and in many cases didn’t receive. In return for referrals, the equipment and service providers allegedly paid kickbacks to the doctor involved. The strike force increasingly targets physicians. “You need a doctor in all the schemes,” said David O’Neil, a deputy assistant U.S. Attorney General. The team charged 36 doctors with health-care fraud in the 2013 fiscal year.