Healthcare News & Insights

Is the mob moving into Medicare?


Medicare fraud, a typically non-violent, white collar crime, is turning into a much more dangerous game. And any health care facility is a potential target.

Blame it on the bad economy perhaps, but authorities throughout the country are reporting an uptick in violent crime related to Medicare fraud.

Because of the relatively low penalties if caught — and the high paydays if they’re not — violent street criminals and some organized crime families are turning to Medicare fraud.

The schemes range from crimes like identity theft and computer hacking (to get patient info to submit in false invoices) to murder when questions start being asked about missing or misused data. Convicted murderers have even been able to get licensed as Medicare suppliers — as long as felony convictions are at least 10 years old, it’s not a barrier to licensing.

Who’s at risk?

Although the crimes are taking place all over the country, some regions have seen more activity. In particular, Miami, Houston, Los Angeles and Detroit have had more than their share of fraud rings. In Southern California alone, a special fraud task force has arrested more than 50 suspects in the past three years.

While the feds are the main target of these scams, hospitals and other health care providers certainly aren’t immune from the threat. Medicare fraud rings have been known to intimidate patients, as well as doctors and other staff, into “co-operating ” by providing patient and billing info.

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  1. Joel Holland says:

    Medicare/CMS does not have time to fight organized crime. They are way to busy trying to put all the mom and pop operations out of business. The small home medical equipment dealers. The small home health agencies. The small physician practices. The small town hospitals. If you look at who I just listed, we are the providers of health care that have always gone above and beyond the call of duty to serve and support our patients. Medicare/CMS is making it clear the level of care given is no longer important. Medicare and CMS are doing everything in their power to turn healthcare into a corporate culture. Just look around you.
    If Medicare/CMS would go after the MOB and the individuals who receive training in foreign countries regarding taking advantage of Medicare, they could save BILLIONS of dollars and increase the number of individuals covered and the level of care provided. MEDICARE/CMS DOES NOT WANT TO.

  2. So what else is new??? This has been going on for years and very little has been done that has effectively curtailed these fraudulent activities. If this were curtailed or eliminated – our costs and services would be affordable for all citizens as it should be!

  3. Lionel Walpin says:

    I reported to Medicare a very suspicious clinic’s activity. Russian patients. Large billings to Medicare for tests ordered by a PA. A doctor (M.D) has to sign off after the fact and never has to see the patient. Doctor does not have to be on premises of clinic when the tests are ordered. I turned down at least $ 9000.00 / month to do this and there are several doctors who do this. PA makes $ 9000.00 / month too.

    Huge cost to Medicare.

    Medicare did nothing about it.

  4. Y Williams says:

    60 minutes hosted a very interesting interview last night: MEDICARE FRAUD. One gentleman said he fraudulently stole $20,000,000.00 from Medicare by setting up a bogus business and turning in false claims to Medicare. He bought lists with real people’s social security and Medicare numbers. Only had a store front and files claims. He was caught. He was jsut a John doe citizen expressing how easy it was because of how Medicare system is set up to pay claims. Another lady had not been to a Dr. in 30 years. She started receiving notices from Medicare regarding her claims. She has been calling for 6 years to try adn get Medicare to understand that they were fraudulent charges and so far they (Medicare) have done nothing. The Medicare rep that was iterviewed by 60 Minutes said that they did not have the man power or resources to check out every complaint. 6 year of phone calls? Do’t think they have time to check out the mob. And, I doubt the mob has time to fool with medicare.