New Health Care Law Fights Medicare Fraud

Thanks to the passage of the Affordable Care Act (ACA), law enforcement officials now have important new weapons to stop Medicare fraud and put those who defraud Medicare behind bars. It’s about time!

Thanks to the passage of the Affordable Care Act (ACA), law enforcement officials now have important new weapons to stop Medicare fraud and put those who defraud Medicare behind bars. It’s about time!

Over the years, stealing money from Medicare has become big business. It is estimated that fraud costs the system about $60 billion every year. Medicare fraud is now one of the most profitable crimes in America. A recent 60 Minutes report said that in South Florida, Medicare fraud has now pushed aside cocaine as the number one criminal enterprise.

Profitable Crime 

The perpetrators include not only a few unscrupulous doctors, but also corporate insurance executives, mobsters and violent criminals. Said Brian Waterman, an FBI special agent stationed in Miami, “There are entire groups and entire organizations of people that are dedicated to nothing but committing fraud [and] finding a better way to steal from Medicare.”

With the passage of the new health care reform law, the “risk” of being caught for committing these crimes has increased. That’s because the ACA contains important tools to help combat Medicare fraud. These include tougher criminal sentencing guidelines, stronger monetary and civil penalties, criminalizing the act of “obstructing a fraud investigation,” and a special $350 million fund to help hire more law enforcement professionals. What’s more, the law requires that the savings from these efforts be used to strengthen Medicare and help pay for new Medicare benefits.

$4 Billion Recovered 

Recently, the new ACA program started showing results. In 2010, more than $4 billion was recovered – the highest annual amount ever recovered from people who attempted to defraud seniors and taxpayers. Also, 726 defendants were convicted for health care fraud-related crimes, many of whom were forced to trade in their pin-striped suits for prison stripes.

So far, 2011 has brought more bad news for Medicare criminals. In February, the Medicare Fraud Strike Force charged 111 defendants in nine cities, including health care company executives, doctors and nurses, for their alleged participation in Medicare fraud schemes. These alleged criminal enterprises involved more than $225 million in false billings for services that were unnecessary or never provided.

President Obama has repeatedly said that the improvements to Medicare contained in the Affordable Care Act can be paid for by cracking down on those who commit crimes and by preventing Medicare fraud from happening in the first place. Clearly, every dollar stolen from Medicare is a dollar not being used to treat the sick. It’s good to see that our government has finally gotten serious about recovering Medicare dollars from the pockets of criminals and putting them back into medical care for seniors.