As of September 2022 there were over 65,000,000 people subscribed to Medicare. Most rely on the program to provide them with affordable healthcare services. However, there are individuals and organizations out there who seek to defraud the system and exploit vulnerable patients for their own financial gain.
To provide you with a little insight on how to protect yourself and the Medicare program, we thought it important to share the top 10 Medicare fraud cases in United States history.
- The HealthSouth Fraud – HealthSouth Corporation, a rehabilitation and healthcare services provider, was found to have engaged in a scheme to overbill Medicare for services that were not actually provided. The fraud was orchestrated by the company’s CEO at the time who apparently directed employees to falsify financial statements and manipulate accounting records to hide the fraud. The scheme lasted for several years and resulted in HealthSouth paying $2.7 billion in fines and penalties.
- HCR ManorCare Fraud – HCR ManorCare, a nursing home chain, was accused of providing unnecessary therapy services to patients in order to bill Medicare for higher amounts. The company allegedly pressured therapists to increase the number of therapy sessions per patient, regardless of medical necessity, and engaged in upcoding, which involves billing for more expensive services than were actually provided. HCR ManorCare settled the case for $48 million.
- Tenet Healthcare Fraud – Tenet Healthcare, a hospital chain, was investigated for paying kickbacks to doctors in exchange for patient referrals and overbilling Medicare for unnecessary medical procedures. The company also allegedly engaged in upcoding and improper billing practices. Tenet Healthcare settled the case for $513 million.
- American Therapeutic Corporation Fraud – This mental health provider was found to have submitted false claims to Medicare for group therapy services that were not actually provided. The company also paid kickbacks to patient recruiters and therapists to refer patients to its facilities. The fraud resulted in the submission of over $205 million in false claims to Medicare. Several executives were convicted and sentenced to prison.
- Caremark Fraud – Caremark, a pharmacy benefit management company, was accused of submitting false claims to Medicare for prescription drugs that were never actually dispensed. The company allegedly dispensed generic drugs, but billed Medicare for more expensive brand-name drugs. Caremark settled the case for $6 million.
- Omnicare Fraud – Omnicare, a pharmacy chain, was investigated for providing kickbacks to nursing homes in exchange for referring patients to its pharmacies. The company also allegedly engaged in improper billing practices and dispensed drugs without proper prescriptions. Omnicare settled the case for $2.24 million.
- Quest Diagnostics Fraud – Quest Diagnostics, a medical testing laboratory, was accused of submitting false claims to Medicare for diagnostic tests that were not actually performed. The company also allegedly billed Medicare for unnecessary tests and paid kickbacks to doctors for referrals. Quest Diagnostics settled the case for $302 million.
- Hospice of Arizona Fraud – This hospice care provider was found to have submitted false claims to Medicare for services that were not provided and for patients who were not actually eligible for hospice care. The company also allegedly paid kickbacks to patient recruiters and engaged in improper billing practices. The fraud resulted in the submission of over $9.3 million in false claims to Medicare. Hospice of Arizona settled the case for $12 million.
- Miami-Luken Fraud – Miami-Luken, a pharmaceutical distributor, and ninety people, including doctors, pharmacy owners and elderly patients, were arrested in six cities and charged with submitting fake billings to Medicare worth nearly $200 million.
- Forest Laboratories Fraud – This pharmaceutical company was investigated for paying kickbacks to doctors in exchange for prescribing its antidepressant drugs to patients. The company also allegedly promoted the drugs for off-label uses that were promoted for uses that were not approved by the FDA. This practice is illegal and puts patients at risk by exposing them to potentially harmful medications that have not been properly tested or approved. Forest Laboratories agreed to pay $38 million to resolve allegations that they violated the False Claims Act by paying kickbacks to induce physicians to prescribe the drugs
As a Medicare beneficiary, it’s important to be aware of these cases of Medicare fraud and to take steps to protect yourself from being taken advantage of. By working with a trusted insurance agent like Geldin Insurance, you can ensure that you have the coverage you need to stay healthy and happy, without the worry of fraud or abuse.
At Geldin Insurance, we understand that each individual has unique healthcare needs, and we strive to provide personalized solutions to meet those needs. Our agents are well-versed in the latest Medicare regulations, and we stay up-to-date on the latest trends in healthcare to ensure that we are always providing the best possible service to our clients.
Our commitment to excellence doesn’t stop after you enroll in a plan. We continue to provide ongoing support and assistance throughout the life of your coverage. We’re always here to answer your questions and address any concerns you may have.
In addition to Medicare plans, we also offer a wide range of insurance options to help you protect your health and your financial future. From life insurance to long-term care insurance, we have the expertise to help you find the coverage you need.
At Geldin Insurance, we believe that everyone deserves access to quality healthcare, regardless of their age, income, or health status. That’s why we’re dedicated to helping you find the right Medicare plan for your needs, and to providing ongoing support and guidance every step of the way.
So if you’re looking for a trusted partner to help you navigate the complex world of Medicare and insurance, look no further than Geldin Insurance.
Contact us today to learn more about our services and how we can help you protect your health and your financial future.