Medicare Fraud Case Summary

On May 14, 2013 Attorney General Eric Holder and Department of Health and Human Services (HHS) Secretary Kathleen Sibelius announced “nationwide takedown” by Medicare Fraud Strike Force operations, in eight cities that resulted in charges against 89 individuals, which included doctors, nurses and other licensed medical professionals, for their alleged participation in Medicare fraud schemes involving approximately $223 million in false billings. In Chicago, seven individuals were charged, including two doctors, with a variety of health care fraud schemes. This (sixth) nationwide takedown targeted eight cities: Miami, Houston, Los Angles, Detroit, Tampa, Brooklyn N.Y, and Chicago.
On April 16, 2013, the owner, senior executive of Sacred Heart
(Price & Norris, 2009) The money lost due to fraud increases the costs of providing a full range of legitimate medical services tremendously. Physicians may perform unnecessary procedures to increase reimbursement, which may compromise the safety of the patient. Further, when medical providers bill for services that were never rendered, they end up creating a false medical history for patients which may hinder them from obtaining disability or life insurance policies, at a later date. An inaccurate medical history also influences treatment decisions and allows some third party insurance companies to deny coverage based on a previous medical condition. Health care fraud also tarnishes the reputation of the medical profession and other health care service providers. Additionally, the efforts by the federal and the state government cost taxpayers billions of dollars a year, thus diverting the scarce tax money from other essential services and meeting the needs of elderly and the poor. This diversion of the taxpayer’s money often results in reduced benefit coverage, changes in eligibility for programs such as Medicaid, higher premiums for individuals or their employers, or higher