Federal Law Enforcement Agents Charge 243 People for Medicare Fraud Totaling More Than $700 Million

Federal agents announced the largest Medicare fraud takedown in the history of the Medicare Fraud Strike Force. This nationwide sweep resulted in charges against 243 people for participating in Medicare fraud schemes that generated about $712 million in false billings. Those arrested included 46 licensed medical professionals including doctors and nurses.

The strike force operations are part of the Health Care Fraud Prevention & Enforcement Action Team (HEAT) which has been operating since 2009. This joint initiative between the DOJ and Health and Human Services enables federal agents to focus their efforts to deter fraud and enforce the nation’s anti-fraud laws.

Including the most recent enforcement actions, national takedown operations have resulted in nearly 900 people being charged with perpetrating more than $2.5 billion in fraudulent billings.

Since the Affordable Care Act was passed, the government has increased the resources allocated to fighting Medicare fraud. These resources have allowed the Strike Force to expand and use technology such as advanced predictive modeling to identify areas with a high rate of fraud.

The strike force has been able to increase its success rate with experience. For instance, they target hot spots where the billing data shows a propensity for a high volume of fraud. Such hot spots include both areas in the US and types of health care services that have a high rate of fraud. Because of this, the agents have been increasingly able to stop fraud at its early developmental stages.

Additional partners in this massive sweep included the FBI and the Centers for Medicare & Medicaid Services.