412 Charged in Crackdown on $1.3 Billion Health Care Fraud – The New York Times

WASHINGTON — Hundreds of people nationwide, including dozens of doctors, have been charged in health care fraud prosecutions, accused of collectively defrauding the government of about $1.3 billion, the Justice Department said on Thursday.

Nearly one-third of the 412 charged were accused of opioid-related crimes. The health care providers, about 50 of them doctors, billed Medicare and Medicaid for drugs that were never purchased; collected money for false rehabilitation treatments and tests; and gave out prescriptions for cash, according to prosecutors.

Did you ever wonder why most massive health care fraud occurs under Medicare and Medicaid? 

Could it be because they are administered by a government bureaucracy and contractors … who have no profit motive to worry about? How cynical of me 🤓


6 replies »

  1. In a quick web search, I found: In 2014 total Medicare payments were $595 billion. In 2105 total Medicaid payments were $553 billion, with the Federal share being $349.8 billion.

    The $1.3 billion in fraud was almost certainly perpetrated over a period of years.

    Question: Is the percent of fraud in Medicare/Medicaid higher than in banking, private insurance or business in general?

    My point is not to belittle the fraud in Medicare/Medicaid but to put it into perspective in an economy that is rife with criminal activity in so-called legitimate businesses. Any search of the criminal activity in the pharmaceutical industry, the banking industry, real estate, Wall Street, etc. will demonstrate that we live in an economy steeped in corrupt practices.


    • So I did the math and it come out to 0.2% fraud. And I agree it is quite low or is it. I wonder how much more we are going to pay to investigate, prosecute, and jail the offenders who were unlucky and got caught.


    • But to me it does make a difference when it is the ‘peoples’ tax money being stolen. Private industry, pharmaceutical, banking, real estate, wall street all probably effect the bottom line of the company/corporation. When you are stealing from the IRS, Medicare or Medicaid you are stealing from me and I want it stopped. Maybe it does cost to bring the thieves to justice. If you don’t start somewhere it will just continue. This must be addressed and curtailed even if it is just one step at a time.


      • When you steal from private industry in also drives up costs which in turn often is reflected in higher consumer prices as the cost of doing business. Think how much cheaper prices could be at Walmart if they didn’t have to spend money on “lost prevention” & security.

        And you are correct justice must be served no matter the cost or fraud and thefts will just get worse..


  2. It’s all about incentives. With the government policy of pay and pursue, what is the incentive to pursue? To make more work for yourself?

    What is the incentive to cheat when billing? $1.3 billion divided by 412 is over $3.1 million. That’s a pretty good risk/reward ratio. Let’s wait and see how many charges stick and how many are just billing errors. OH! I seem to have made an error, let me fix that for you.


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