Little did the Republicans suspect, when they voted to kill the Affordable Care Act 50 times, that they were trying to kill a law enforcement act that has netted more than $15 billion in money recovered from fraudulent billing to Medicare. But that is just what investigators partly funded by the ACA have done. And they did it without firing a shot.
Last Thursday, Attorney General Loretta Lynch announced indictments against 243 individuals charged with defrauding the Medicare system. These suspects are charged with defrauding the US government out of $712 million in false medicare billings. The suspects are not patients making bogus claims to get drugs or kickbacks. They are doctors and other medical professionals accused of using their privileged positions to enrich themselves. Their patients were merely tools for the satisfaction of their greed.
Many of these crimes would never have been detected except for the Affordable Care Act, which provided $350 million for enforcement of fraud cases. The ACA created a strike force that combined the resources of federal, state, and local law enforcement agencies. The ACA also expanded the geographical scope of investigations from 2 districts to 9 districts. It seems incredible that, prior to this time, the government did not have the money to go after criminals of this magnitude.
Assistant Attorney General Leslie Caldwell said that her investigations from 2012 to 2014 have recovered 8 dollars for every one dollar spent. So the ACA funds spent on fraud investigation have paid for themselves 8 times over. The investigations are done by obtaining and analyzing billing records in real-time. The feds spot suspicious billing activity and hand the cases over to local investigators.
A nursing home in Florida found a new way to steal from medicare. They used their dementia patients as pawns, diagnosing them with psychological ailments and billing the government for treatments that amounted to nothing more than moving them to another room in the facility. The doctors involved in this scam billed the government for $32 million worth of psychiatric sessions, frequently for patients who couldn’t even talk.
A doctor in Michigan is accused to providing narcotics to his patients in return for his use of their identifications to bill the government for nonexistent drugs. The doctor thus kept the addicts from receiving treatment that could have cured them of addiction. In addition, if the addicts tried to get out of the arrangement, he threatened to cut off their supply of drugs.
One doctor in southern California fraudulently charged more than $23 million to Medicare, including bills for 1,000 expensive power wheelchairs.
These revelations are unprecedented and astonishing, but also remarkable is the fact that few people have heard the announcement, since the news media have been talking about nothing but the Charleston shootings on Thursday.