A spate of medical fraud prosecutions has dominated the news. According to the Justice Department, since 2007 over 1,300 people have been charged with falsely billing Medicare in excess of $4 billion. Undoubtedly there is far more to come. By today’s standards the sums ring like petty cash. Following an almost five-year federal investigation into its billing practices the University of Washington was charged with Medicare fraud and subject to a $35 million penalty. More spectacular was the tarnishing of the premier medical institution’s once-spotless reputation. Two internationally-renowned physicians received felony convictions. Just beneath the shiny surface, investigators discovered, lay a culture of secrecy and fear, where clerks were ordered by superiors to forge signatures and alter records. The wrongdoing involved dozens of doctors and eight departments. That was in 2004. At the time the UW settlement payment was unprecedented in size for an academic institution. Far larger penalties would be accorded to Columbia/HCA. In late 2002 the for-profit entity agreed to pay the U.S. government $631 million, plus interest, in addition to hundreds of millions in other fees to settle state Medicaid claims and Medicare fraud. Many questioned whether these two different cases represented isolated, aberrant behavior or were simply “the tip of the iceberg.” Recent events show the latter is true. A spate of medical fraud prosecutions—including a federal takedown earlier this month that covered 107 healthcare workers in seven cities and totaled $452 million—has dominated the news. According to the Justice Department, since 2007 over 1,300 people have been charged with falsely billing Medicare in excess of $4 billion. Undoubtedly there is far more to come. It’s been reported that the FBI is currently investigating over 2,600 cases using more than 500 agents and analysts. A jury began deliberations this week in the trial of a Miami-based chain of mental health clinics that billed Medicare hundreds of millions for psychotherapy. The company was “corrupt from top to bottom,” the government said in its opening remarks. Dentistry is not immune to Medicare fraud, although the money at stake is considerably less. On Tuesday a Virginia dentist was convicted of filing $160,000 in false claims. So how to account for the high-profile cases? Do we simply live in a more dishonest time, where theft has accelerated because of an uncertain economy? Not really, most observers maintain. Insurance fraud is as old as insurance itself, says John Bitting. DOCS Education’s regulatory counsel believes that while the sums attached grow ever larger that doesn’t mean the percentage of dishonest practitioners is greater. “The rise in successful prosecutions reflects the government’s greater concentration on chasing Medicare fraud. That tactic has become one of the most potent ones in the war against runaway healthcare costs.”
