Federal officials in recent years have increasingly worked to combat Medicare and Medicaid fraud.
In fact, at the beginning of his second term, President Barack Obama made the issue a top priority, according to The Fiscal Times. Since then, there have been a number of high-profile arrests and prosecutions for fraud by federal and state law enforcement agencies.
Here are six things to know about Medicare and Medicaid fraud enforcement.
1. Skilled nursing facilities are facing more scrutiny from the federal government and are the target of several healthcare fraud enforcement actions, according to Bloomberg BNA. Joseph E.B. "Jeb" White, a whistle-blower attorney with Nolan Auerbach & White, told Bloomberg the Department of Justice plans to more thoroughly investigate SNFs for medically unnecessary therapies, which has spurred whistle-blower cases targeting SNFs. Here are three things to know about three recent fraud cases involving SNFs, according to Bloomberg.
2. Last month, Prime Healthcare Services asked a federal court to exclude certain evidence used by the DOJ in a lawsuit alleging the Ontario, Calif.-based hospital chain violated the False Claims Act. The DOJ intervened in a whistle-blower lawsuit against Prime in May. The lawsuit alleged Prime defrauded the federal government of millions of dollars by billing Medicare for medically unnecessary inpatient short-stay admissions, which should have been classified as outpatient or observation cases. In a motion filed in September, Prime asked the U.S. District Court for the Central District of California to issue an order excluding the DOJ's use of statistical sampling and extrapolation in the case.
3. The DOJ charged a hospital administrator, physician's assistant and the owner of more than 30 Miami-based nursing and assisted living facilities in connection with a $1 billion Medicare fraud and money laundering scheme in an indictment unsealed last July. Operator Philip Esformes, 47, administrator Odette Barcha, 49, and nurse practitioner Arnaldo Carmouze, 56, were charged for their role in the scheme. All are residents of Florida's Miami-Dade County.
4. The DOJ announced in June that its Medicare Fraud Strike Force set a new record this year for the largest takedown of medical professionals attempting to defraud Medicare. This year's sweep resulted in criminal and civil charges against 301 individuals, including 61 physicians, nurses and other licensed medical professionals for allegedly participating in schemes involving $900 million in false billings. Those numbers top the record setting sweep in 2015, which resulted in charges against 243 individuals who allegedly submitted $712 million in false billing to payers.
5. Penalties under the False Claims Act, which previously ranged from $5,500 to $11,000 per claim, nearly doubled Aug. 1. The Bipartisan Budget Act of 2015, signed into law by President Obama last November, requires federal agencies to increase civil monetary penalties awardable under the False Claims Act. One of the law's provisions includes a "catch up adjustment," which requires agencies to update penalties to account for inflation. The initial adjustment was implemented through interim final rulemaking, like that recently promulgated by the DOJ.
6. Since 2010, the federal fraud taskforce arrested and prosecuted about 1,200 people allegedly involved in defrauding Medicare and Medicaid of more than $3.5 billion, according to The Fiscal Times, which cites information from the DOJ.