In a recent major federal Medicare fraud crackdown, a total of 89 people were charged on Tuesday for false billings totaling $223 million. Charges applied to doctors, physical therapists, nurses and other medical professionals across eight cities, including New York.
In many instances, the criminals were involved in fraudulent billing such as charging for home health care and psychotherapy when service was never performed or was not medically necessary.
This latest crackdown is the sixth “national takedown” by the government’s Medicare Fraud Strike Force. Since 2009, it has arrested more than 1,500 people on charges related to nearly $2 billion in false Medicare claims.
The efforts by the Medicare Fraud Strike Force help tame government healthcare spending and directly impact the federal budget deficit. There is a return of about $8 to the Treasury and the Medicare trust fund for every $1 invested, according to U.S. officials.
For decades, Medicare operated under pay and chase, where providers are paid first and suspicious claims are investigated later. Now, payment can be suspended immediately when providers face fraudulent Medicare claims.
For the charges in New York, they involve four individuals, including two doctors for false billing to Medicare and Medicaid programs that total more than $17 million. The New York medical professions and individuals charged include psychiatrist Mikhail L. Presman, 55, medical doctor Chang Ho Lee, 66, and the manager and medical biller for Lee, Michelle Lee, 58, and Francis Choi, 54.
Even with the progress and savings resulting from cracking down on Medicare fraud, budget cuts called sequestration may impact future progress. “Unless Congress adopts a balanced deficit reduction plan and stops the reduction currently slated for 2014, I fear our capacity to protect the American people from healthcare fraud… will be further reduced,” stated Attorney General Eric Holder.