Feds Recovery $4 Billion in Fraud in 2009

Last year, the Federal government recovered more than $4 billion in health care fraud. It may not seem much, but when you consider it was only a few agents in a handful of cities and a few bold individuals who brought forth qui tams under the False Claims Act, it is quite significant.

Here are highlights of some of my favorite child welfare schemes of 2009:

• In Mississippi a Psychologist conspired with others to submit false and misleading patient diagnosis to the Social Security Administration in order to assist many of his patients to obtain disability benefits. Once a patient was approved for disability benefits, Medicare was billed, claiming that he was providing psychological health care services to patients on a weekly or semi-weekly basis, when in fact, he was treating these patients only a few times a year, if at all.

TRANSLATION: Psychologists label foster kids with made up disorders like Separation Anxiety, Bi-polar, ADHD, Defiance and Depression, prescribe heavy doses of unnecessary medication,  then submit false reports to the court to keep the kids in foster care longer, and do not provide any services that are billed to Medicaid.

• In Michigan and New York, the States claimed Medicaid reimbursements for outpatient expenditures for drug products that were not eligible for Medicaid coverage because they were dispensed after their termination dates or less than effective. In addition, the States claimed for drug products that were not approved by Medicaid.

TRANSLATION: Child welfare psychological services provided foster children with large doses of out-dated and unnecessary medication to keep them in the system longer and billed Medicaid.

• Pennsylvania did not comply with federal and state mandates in Targeted Case Management by billing for service unsupported by case records or insufficiently documented.

TRANSLATION: Judges were sending kids to jail and foster care for, for no reason, got kiddy kickbacks and billing Medicaid.
DHHS and DOJ Annual Health Care Fraud and Abuse Control Program Annual Report for FY 2009

The one thing that should be noted is the States Medicaid Fraud Units had absolutely nothing to do with recoveries because of the inherent conflicts of interest in child welfare.

"Criminals have concluded that health care fraud is a safe bet. It is
imperative that we change the calculus," said Daniel R. Levinson,
Inspector General for the Department of Health and Human Services.