U.S. Recovers $42.3 Million in Crackdown on Medical Fraud

WASHINGTON — A crackdown on Medicare and Medicaid fraud in five states over the last year has produced $42.3 million in recovered funds, the Department of Health and Human Services said Monday.

That’s a return of $10 for every $1 spent by the federal government on the pilot project in New York, Florida, Illinois, Texas and California, federal officials said.

“In its first year, Operation Restore Trust has proved its value, and the president wants to extend its reach to every state in the nation,” said HHS Secretary Donna Shalala. President Clinton’s 1997 budget proposal seeks funds for a nationwide program.

The focus of the pilot project has been on home health agencies, nursing homes and medical equipment suppliers. Those convicted of fraud have been ordered to pay restitution and fines, which have been deposited in the Medicare Trust Fund and U.S. Treasury.

A case cited by HHS Inspector General Judy Gibbs Brown involved a woman in a nursing home who attended a get-acquainted coffee shortly after she arrived. In going through her bills, her son discovered she had been charged for group therapy.

“Everybody who attended the coffee was being charged through Medicare for group therapy sessions,” Brown said.

Of the 272 Medicare and Medicaid cases under investigation, 244 were opened as a result of the pilot program, she said, adding that 64 of them are in conjunction with other law enforcement agencies.

The five states account for 38.5% of the nation’s Medicaid beneficiaries and 34% of all Medicare beneficiaries.