In what US authorities called the largest Medicare fraud takedown in history, raids involving 350 agents were carried across the USA, including Houston, Detroit, New York, and Miami. So far, 94 people have been charged - many of them healthcare professionals - in scams totaling over one-quarter of a billion dollars.

Apparently, this is only the tip of the ice-berg. Estimated Medicare fraud could be anywhere from 60 billion to 90 billion dollars, authorities believe.

Under President Obama's Affordable Care Act, authorities can now order the suspension of payments to providers suspected of fraud.

Yesterday, Kathleen Sebelius, US HSS Secretary, and Eric Holder, US Attorney General, kicked off the first in a series of Regional Health Care Fraud Prevention Summits in Miami, Florida. The summit held a wide-range of federal, state and local partners, beneficiaries, providers and other parties to discuss ways of eliminating fraud in the American health care system.

Sebelius said:

The days of scamming dollars from our health care system are over. Thanks to new tools contained in the Affordable Care Act, we are more prepared than ever to safeguard taxpayer dollars and ensure that the health care coverage of our seniors, families and children is secure. I'm proud of the tremendous success we've had so far, and look forward to continuing this important dialogue at fraud prevention summits across the country.

Holder said:

Despite all that's been accomplished over the last year, we cannot yet be satisfied or become complacent. And we cannot ignore the fact that health care fraud remains a significant problem. Each of you can be part of this and other public education efforts. Each of you can help to ensure that our health reform achievements are not exploited.

Miami seniors were privy to a new training video which teaches them how to detect suspected Medicare fraud and how to report it to 1-800-HHS-TIPS.

The summit also included educational panels that talk about best practices for law enforcement and providers in preventing Medicare fraud.

According to an HSS press release:

The recently enacted Affordable Care Act provides additional tools and resources to fight fraud in the health care system by providing an additional $350 million over the next ten years through the Health Care Fraud and Abuse Control Account (HCFAC). In addition, the Affordable Care Act toughens sentencing for criminal activity, enhances screenings and enrollment requirements, encourages increased sharing of data across government, expands overpayment recovery efforts, and provides greater oversight of private insurance abuses.

According to authorities, 33 suspects have been indicted in the Miami area, charged with scamming Medicare out of $140 million. Miami was chosen as the summit venue because it is ground zero for Medicare fraud.

Types of fraud discovered were varied an intriguing. Miami GP (general practitioner, primary care physician), Dr. Joege Dieppa, 56, is accused of taking kickbacks for patient referrals to home healthcare agencies which generated $18.7 million in false Medicare claims. Over 300 patients were referred for unnecessary and expensive diabetes therapies, as stated by the indictment. $11.8 million were paid to Dieppa's team, which included a group of nurses and one patient who received backhanders. When federal agents arrived, Dieppa was enjoying a European cruise.

A Brooklyn scam was found to have conned Medicare out of $72 million for bogus claims for physical and occupational therapies for Russian immigrants. Undercover agents and wiretaps were involved in the investigation.

Source: HHS