Authorities bust massive Medicare fraud scheme

Created date

January 24th, 2020
Medicare forms like this one are full of sensitive information you wouldn't want getting into the wrong hands.

Medicare forms like this one are full of sensitive information you wouldn't want getting into the wrong hands.

Last year, federal authorities disrupted one of the largest health care fraud schemes ever investigated. 

The scheme involved fraudulent telemedicine firms, medical professionals, and medical equipment companies. 

The fraudsters obtained unnecessary prescriptions for durable medical equipment (DME) like knee, back, shoulder or wrist braces. Sometimes, shady medical providers worked with the scammers in return for a kickback, while some scammers outright stole the identities of legitimate health care providers.

Consumers were encouraged to order DME “free of charge” even though they didn’t need the equipment, and the fraudulent equipment suppliers then billed Medicare.

“The defendants took advantage of unwitting patients who were simply trying to get relief from their health concerns. Instead, the defendants preyed upon their weakened state and pushed millions of dollars’ worth of unnecessary medical devices, which Medicare paid for, and then set up an elaborate system for laundering their ill-gotten proceeds,” says U.S. attorney Craig Carpenito.

These indicted fraudsters (24 in all) were allegedly responsible for over $1.2 billion in losses.

“The same spoon that serves indictments on drug dealers, felons in possession of firearms, and corrupt officials will also feed those companies and individuals who engage in Medicare fraud. White-collar crime is not victimless,” says U.S. attorney Sherri Lydon. “All taxpayers will endure the rising cost of health care premiums and out-of-pocket costs as a result of fraud on our Medicare system.”

Though these scammers were busted, thousands more continue to prey on unsuspecting consumers. 

What you can do

Here’s how you can protect yourself:

• Never give out your Medicare number to anyone other than your physician’s office— especially if you receive an unsolicited phone call or letter.

• Never accept any free medical equipment in exchange for your Medicare number.

• Carefully review your Medicare Summary Notice statement or Explanation of Benefits. Report any discrepancies immediately.  

If DME that you didn’t order arrives at your home, report it to 1-800-MEDICARE (1-800-633-4227) so it will not be billed against your medical benefits. If you don’t report it, you might not be able to get Medicare to cover the same type of DME if you do need it in the future. 

After you report it, you can send it back or keep it at no cost. You never have to pay for anything you receive in the mail that you didn’t order. 

“Our law enforcement officers are focused on preventing and uprooting health care fraud schemes like those alleged today,” says Gary Cantrell, deputy inspector general for investigations at the Department of Health and Human Services. “These schemes divert money from taxpayer-funded federal health care programs into the hands of criminals. Working closely with our law enforcement partners, our agency will continue to investigate and disrupt attempts to undermine Medicare and target beneficiaries.”