Tag: Medicaid
Nearly 40% of patients postponed medical care for themselves or a family member in 2022 due to cost. The percentage jumped 12 percentage points in a year, from 26% in 2021 to 38% in 2022, according to Gallup's annual Health and Healthcare poll. While this trend has clear ramifications for healthcare, it's also bound to affect revenue and collections for healthcare providers. Providers need to stay ahead of the curve when it comes to navigating staff shortages, decreased patient volume, and the range of financial problems patients are currently facing. Matt Hanas, Lead Product Manager at Experian Health, shared how providers can improve collections as patients postpone care. Q1: New studies show that many patients are putting off care due to costs. What does this mean for collections? “We're hearing about this very exact concern directly from our clients,” says Hanas, “and it's unfortunate to see patients put off medical care due to rising costs. Patients across our nation are struggling to balance where to allocate their hard-earned dollars, and they're having to make difficult decisions about whether to seek medical care or use that money on their everyday necessities. Meanwhile, healthcare providers are once again adapting to a shifting climate: “Clients are meeting this trend head-on with adaptable plans of action that allow for customizable contact strategies driven by automation and powerful data sources, using Experian solutions like Collections Optimization Manager,” says Hanas. “[Postponed care] doesn't have to be a heavily felt impact in collections if health organizations can quickly and easily adjust their collections strategies according to economic shifts, such as reduced patient volumes.” When volume is down, efficiency is key. “Experian's suite of products allows clients to utilize the tools and data we can provide to pivot on some of their outreach approaches,” Hanas says. “Segmentation results allow them to consider, for example, focusing on lower balance accounts with a consistent pattern of good payment history, or increasing collections efforts on higher balance accounts that may be harder to collect on. Having access to this data and following it is very key in preventing significant revenue interruptions during these patient volume shifts that we are seeing right now.” Q2: How can providers improve collections amid staffing shortages? “Automate as much of your workflow as possible,” Hanas advises. Automation not only reduces the need for staff intervention but also helps manage the complexity that comes with postponed care. Patients who have put off getting medical treatment may require more extensive (and expensive) treatment. If they've postponed care because of cost, it could be a sign that their finances are stretched. A complicated collections environment needs more than additional staff hours; it calls for data-driven insights and automation. “Visibility, powered by data, drives actionable workflows,” says Hanas, who points out that using solutions from Experian Health allows healthcare providers to accomplish more with fewer staff, including: Automatically pushing updates into an EHR system without manual intervention Setting up automated, prescheduled dialing and texting campaigns Prioritizing collections based on propensity to pay Adjusting scrubs and screens on AR files to remove accounts that are unlikely or unable to pay Sending text-to-pay message alerts Giving patients self-service payment options through online portals and mobile apps “I'm not saying you can completely replace the human touch throughout collections,” says Hanas. “But automation, data-driven insights, and user-friendly, self-sufficient payment collection tools can minimize the impact felt from staffing shortages by ensuring that staff collections efforts are efficient, and by offering patients that power, that freedom to use the self-service payment tools they are very eager and willing to use.” The return on investment speaks for itself. “Our collections solutions have a 9:1 return on investment ratio, based on clients' 2022 data,” says Hanas. “We think that's a pretty remarkable ROI.” Find out how University of California San Diego Health used Collections Optimization Manager and Coverage Discovery to increase collections from $6 million to $21 million. Q3: How does access to multiple sources of data improve collections success in the current environment? “Data gives our clients a compass that guides them very precisely, so they know which patients to focus on and what strategies to deploy,” says Hanas. “Experian is one of the largest data aggregators in the world, which benefits products like Collections Optimization Manager heavily—but it doesn't stop there. Experian Health doesn't rely solely on credit data; it also includes non-credit consumer data. We continually partner to grow our arsenal of data sources, so clients have a laundry list of solutions and products powered by this accumulated portfolio of data sources.” Here's how providers are using Experian's suite of collections solutions to help patients and improve collections efforts: Qualifying patients for Medicaid - “Data sources may show coverage that's been simply overlooked or forgotten by the patient,” says Hanas. “For example, Coverage Discovery has found a ton of Medicaid coverage for patients who simply didn't know they had it—or who failed to report it.” Recently, the expiration of the COVID-19 public health emergency caused millions of patients to lose their Medicaid coverage overnight. In these cases, providing information to patients who are confused about coverage benefits both providers and patients. Hanas notes: “When we find patients are eligible for Medicaid coverage, they're really pleased to find out that their self-pay balances will be covered.” Filtering out difficult-to-collect accounts can improve collections - Screening can save providers valuable time and resources they might otherwise spend trying to collect from patients who are unable to pay. Hanas says, “Simply being able to identify that someone's address is not current or deliverable saves providers money on statement processing and postage—and saves them the trouble of attempting to send a bill that cannot be delivered.” Gaining insight into financial circumstances - “Our data gives our clients visibility into consumers' financial status changes—paying off a car loan or securing a new mortgage, for example, are things that our clients really need to know. By monitoring these financial status changes, our clients can increase or decrease their collections efforts based on what they see,” Hanas explains. Q4: How can providers support their patients who may need extra financial assistance? “Identifying patients who are eligible for charity care and other forms of assistance is probably the most rewarding use of our data, models, and algorithms,” says Hanas. “Patient Financial Clearance, which falls under the Collections Optimization suite of products, shows which patients may automatically qualify for charity. For those who do, clients can set up automation rules on the back end to automatically write off balances. This happens through a seamless integration, so it's virtually effortless. “Providers can also use the propensity to pay tool in Patient Financial Clearance to identify patients with a low likelihood of paying and offer payment plans that may help them meet their obligations. By having these conversations early in the process, healthcare organizations can keep more accounts out of collections and patients can receive medical care without having to worry about what's going to come after their visit.” The bottom line “Clients want to centralize their business operations around their patients and their care, to find the best approaches to looking after patients' health as well as their financial health,” Hanas says. “We don't want to send everyone who has a balance to collections: We want to use the different tools we have to assist them up front so they can get the medical care they need without feeling stressed and thinking about possible bills down the line. Learn more about how Collections Optimization Manager and Experian Health's full suite of collections solutions can help providers protect profits and drive revenue.
On April 1, 2023, millions of Medicaid recipients are set to lose coverage as the U.S. government’s COVID-19 public health emergency (PHE) expires. The Kaiser Family Foundation estimates that 5.3 to 14.2 million people will lose Medicaid coverage as the continuous enrollment provision of the PHE ends. Of this group, 6.8 million may be eligible to re-apply for Medicaid, but in the immediate term, it falls to patients and providers to sort through coverage questions, navigate charity and Medicaid eligibility, and keep bills out of collections. Mindy Pankoke, Senior Product Manager at Experian Health, shares her insights on how Patient Financial Clearance and other digital solutions can help providers and patients cut through the confusion to achieve the best healthcare and financial outcomes during this time. Q1: The public health emergency is ending on April 1, which means that many will lose Medicaid coverage. How will this impact providers and patients? “Patients who qualified for Medicaid under the Public Health Emergency requirements during COVID will be dropped from Medicaid on April 1, leaving them without coverage,” explains Pankoke. “Healthcare organizations have been trying to reach out proactively to pre-enroll some of these patients, but others may not know what their options are or may show up to receive care without realizing they no longer have coverage.” Patients will face a range of financial challenges. “Self-pay patients may defer treatment, which could keep them from receiving the care they need and may ultimately lead to more costly hospital visits,” Pankoke says. “Also, patients may be confused about what’s happened to their coverage and what their options might be going forward. If they end up being responsible for paying out of pocket for care, some may have to choose between paying their medical bills and paying for food or utilities.” Providers will see a surge in patients needing help after losing Medicaid coverage With millions of patients in flux, providers will need to dedicate time and attention to helping patients sort through their concerns, including: Confirming whether Medicaid coverage is still in force Verifying coverage with new insurance Determining eligibility to re-enroll in Medicaid Qualifying patients for full or partial charity care Explaining patient financial responsibility and working out payment plans Managing billing and collections with a higher volume of accounts in AR Optimizing outcomes so that patients get the best care possible and providers end up with the least amount of bad debt Time is a critical element. Lengthy processes and administrative delays are likely to increase patient stress levels. Meanwhile, many providers face industry-wide staffing shortages. Time-consuming manual processes, multiplied by a sudden surge of affected patients, could quickly become overwhelming for staff. “For providers, this could be a hard situation to navigate,” says Pankoke. “At the same time, it gives providers an opportunity to come through for patients in a moment of need. Being able to identify patients who need assistance and offering them help can be powerful.” Q2: That raises an important question: How can providers create a compassionate experience for patients? “I think awareness is one place to start: making sure your staff knows this change is coming and that they understand the impact,” Pankoke says. “Your staff are the ones who’ll be working with patients personally when they come in and find out they no longer have Medicaid coverage.” But compassion doesn’t end there. “Many providers already have charity programs in place to provide relief for patients who can’t afford care,” says Pankoke. “The challenge lies in identifying the patients who need that charity assistance and connecting them to the help that’s available, while also learning which patients may still qualify for Medicaid and need help to re-enroll. Patient Financial Clearance uses credit and non-credit data to identify patients who may still be eligible for Medicaid, as well as self-pay patients who may qualify for charity assistance.” Using data-driven digital tools to quickly and proactively size up patient financial needs and offer personalized help can make the patient experience more humane. “Making these steps easier is another piece of being compassionate.” Q3: Screening for charity can be complicated, especially when new regulations are introduced – how do providers streamline this process? “My best advice is to embrace your charity programs and use a partner like Experian Health to help you automate the financial assistance screening process,” says Pankoke. “Patient Financial Clearance removes the manual screening for the likelihood to qualify for your charity programs and Medicaid. It can automate the document-gathering in a patient-friendly way, and speed up the process to extend charity assistance, or work to enroll those likely to qualify for Medicaid early on before patients go through a costly uncollectable experience.” Automating these processes doesn’t have to be onerous. “Clients can provide their charity policy requirements to Experian Health and let our expert consultants help to create the most effective and efficient workflows for Medicaid and charity screening both up-front and as back-end scrubs.” Pankoke also urges providers to consider patient self-screening options as well: “Providers should consider other options aside from paper applications. We’ve seen clients shrink the application process from 60 days of paperwork down to 3.5 days by enabling patient self-screening options via text. This creates a better experience for the patient and hospital staff.” Q4: What else can providers do to help patients manage the cost of care? Providers can focus their resources on improving the patient's financial journey—for all patients, not just those who are struggling with their Medicaid status. Pankoke’s suggestions: Reach patients on their preferred channels - “Providers can empower patients with less paper-heavy ways to apply for financial assistance. Text and online applications embedded on your website or patient portal put the power into the patient’s hands using the channels they prefer.” Providers can also offer patients the ability to make payments right from their mobile devices using Patient Financial Advisor, making it easier to pay outstanding bills anytime and anywhere. Use data to gain insight into patient finances and offer personalized options - “In addition to screening for possible charity and Medicaid eligibility, Experian data enables providers to offer realistic payment plan options that consider how much the patient is likely to afford, enabling patients to bite off what they can chew with higher likelihoods of making payments successfully.” Customize collections - Sending patients who are struggling to collections may not be cost-effective or compassionate. “Providers don’t want to hound people for payment if the patient is having trouble covering their basic expenses and could qualify for Medicaid or charity care,” says Pankoke. Using Collections Optimization Manager, providers can tailor collections processes to their own specific needs. “A partner who is agnostic to your in-house and early-out agencies can help you manage, monitor, and optimize agency performance for maximum revenue.” Providers who are concerned about upcoming shifts to Medicaid coverage may want to consider leveraging solutions like Patient Financial Clearance, Collections Optimization Manager and Patient Financial Advisor to help them meet this challenge—along with the many challenges of managing patient financial needs in a rapidly-changing world.
Medicaid continuous enrollment will come to an end on March 31, 2023, as the temporary provisions are decoupled from the COVID-19 public health emergency. The federal government introduced the protections to ensure individuals did not lose coverage during the pandemic, leading to record enrollment levels. But as states prepare to resume routine renewals, up to 15 million people could end up without adequate insurance. Coverage gaps could disrupt access to health services and increase the risk of uncompensated care for providers. With Medicaid continuous enrollment coming to an end, how can providers prepare? Mitigating the effects of the unwinding of the Medicaid continuous enrollment provision Under the Consolidated Appropriations Act passed in December 2022, states will have 14 months to complete renewal processes for Medicaid and the Children’s Health Insurance Program (CHIP). While 6.8 million people are likely to remain eligible, churn and administrative delays could leave some without coverage. Analysis by the Kaiser Family Foundation suggests that in recent years, around 65% of people who disenroll from Medicaid or CHIP experience a gap in coverage for all or part of the following 12 months. Some transition to other forms of coverage, but around 41% eventually re-enroll. Implementation of the forthcoming “unwinding” process largely falls to states. While the new legislation and associated guidance bring welcome certainty, concerns remain around how to avoid unnecessary disenrollment and expedite redetermination. That way, patients (and providers) aren’t left holding bills that could have been covered when the Medicaid continuous enrollment period ends. 4 things providers can do if a patient loses Medicaid coverage As patients steel themselves for the return of renewal paperwork, providers are considering how they can help patients maintain coverage and get the financial assistance they need. Digital self-service tools to apply for financial assistance can help patients access the appropriate support, with tailored payment plan options based on their individual financial situation – all through automation. Here are 4 key actions for providers to consider: 1. Find missing coverage with Coverage Discovery Healthcare providers should put automated processes in place to find any active coverage that may have been overlooked. Coverage Discovery searches for any billable government or commercial insurance to eliminate unnecessary write-offs and give patients peace of mind. Using advanced search heuristics, millions of data points and powerful confidence scoring, this tool checks for coverage across the entire patient journey. If the patient’s status changes, their bill won’t be sent to the wrong place. In 2021, Coverage Discovery identified previously unknown billable coverage in more than 27.5% of self-pay accounts, preventing billions of dollars from being written off. 2. Quickly identify patients who may be eligible for Medicaid and financial assistance A lack of clarity around enrollment and eligibility could cause chaos for claims and collections teams. How can they handle reimbursements and billing efficiently if financial responsibility is unclear? Claim denial rates are already a top concern for providers, on top of wasted time from seeking Medicaid reimbursement for disenrolled patients. Equally, patient collections will take a hit if accounts are designated as self-pay when the patient is entitled to financial assistance and charity care. It may be difficult to tell who’s who without a robust process to check patients’ ability and propensity to pay. With Patient Financial Clearance, providers can quickly determine if patients are likely to qualify for financial support, then assign them to the right financial pathway, using pre- and post-service checks. Self-pay patients can be screened for Medicaid eligibility before treatment or at the point of service, and then routed to the Medicaid Enrollment team or auto-enrolled as charity care if appropriate. Post-visit, the tool evaluates payment risk to determine the most suitable collection policy for those with an amount to pay and can set up customized payment plans based on the patient’s ability to pay. Patient Financial Clearance also runs back-end checks to catch patients who have already been sent a bill but may qualify for Medicaid or provider charity programs. This helps providers secure reimbursement and means patients are less likely to be chased for bills they can’t pay. 3. Screen and segment patients according to their propensity to pay Optimizing collections processes is always a smart move for providers, and will be particularly important when federal support ends. Collections Optimization Manager uses advanced analytics to segment patient accounts based on propensity to pay and send them to the appropriate collections team. With access to Experian’s consumer credit data, the Collections Optimization Manager segmentation models are powered by a more unique and more catered approach that includes robust and proprietary algorithms. It screens out Medicaid and charity eligibility, so collections staff focus their time on the right accounts. Between 2019-20 and 2020-21, UCSDH increased collections from around $6 million to over $21 million with Collections Optimization Manager. Altru Health System also used this solution to ensure that patients who were eligible for Medicaid were not allocated to collections and their insurance was billed promptly. Over a 10-month period, more than 4,000 accounts were flagged as eligible for financial assistance, representing nearly $2.7 million. This automated process also alleviates the burden on staff, who will likely be handling greater numbers of queries from anxious patients when continuous enrollment ends. 4. Make it simpler for patients to manage and pay bills The reality is that many patients affected by the unwinding of continuous enrollment will be on low incomes. When more than half of patients say they’d struggle to pay an unexpected medical bill of $500, providers need to take steps to make it easier for patients to gauge their upcoming bills. Digital, self-service tools such as Patient Financial Clearance can help self-screen for charity and financial assistance. Patient Financial Advisor and PatientSimple can help patients navigate the payment process with pre-service estimates, access to payment plans and convenient payment methods they can access on a computer or mobile device. Together, these tools can help providers manage the fluctuating Medicaid continuous enrollment landscape efficiently and offer extra support to patients who may be facing disenrollment. Find out more about how Patient Financial Clearance and other digital solutions can help healthcare organizations deliver compassionate financial experiences to their patients.
Over the last twenty years, American hospitals have provided more than $620 billion of uncompensated care for cases where no payment was made by a patient or insurer. This includes financial assistance, where hospitals provide care at a reduced cost for those unable to cover their full bill, and bad debt, where patients have not applied for financial assistance and cannot or will not pay their bill. Despite extensions to Medicaid coverage under the Affordable Care Act, the number of uninsured people in the United States is still approaching 30 million. For these often-vulnerable populations, safety-net hospitals provide essential care regardless of the patient’s ability to pay. But safety-net hospitals are themselves under increasing financial pressure, experiencing more than double the uncompensated care costs of other acute hospitals. And when safety-net hospitals are closed down or struggle to meet demand, nearby hospitals must cover the shortfall in care. It’s a problem for everyone. A Kellogg Insight report found that when more people are uninsured, hospitals bear the cost by providing uncompensated care to the tune of $900 for each additional uninsured patient. Craig Garthwaite, Assistant Professor of Strategy, describes hospitals as “insurers of last resort”: “People are still going to the emergency room and they are still receiving treatment – so the cost is still there. When governments do not provide health insurance, hospitals must effectively provide it instead.” Hospitals might respond to the burden of uncompensated care in three ways: shifting the cost of care to other payers, cutting the cost of services to all patients and removing unprofitable services, or accepting lower total profit margins. All have the potential to damage quality of care as well as revenue and workflow. But beyond these major systemic responses, there are steps providers can take to reduce their risk of unpaid care and optimize their existing revenue framework. Protect your revenue by finding missing coverage quickly The new reimbursement landscape forces providers to manage more self-pay patients, with high-deductible health plans and health savings accounts. This puts a lot more responsibility and stress on patients themselves, who may not be able to afford their co-payments. Uncovering missed or undisclosed insurance coverage is also costly and time-consuming for providers. Regardless of ability to pay, if your patients are wrongly classified as uninsured or as having only one insurance option, you’re likely to lose revenue. As the financial risk of uncompensated care continues to grow, there are important questions for healthcare executives to consider: How do you decrease your accounts receivable balances and self-pay write-offs? How do you increase cash flow from re-billed claims? Are you missing any opportunities to bill additional payers for services? Are you identifying coverage for emergency department inpatients in time to meet your notice of admission requirements? The answers boil down to having the right processes in place to discover which patients can and cannot afford to pay, ideally before they go through the billing system. When you know this, you can move quickly to direct them to alternative sources of funding. How to find insurance coverage to avoid bad debt and charity write-offs An automated coverage discovery solution could help you identify patient accounts that don’t have sufficient insurance coverage, without the expense and hassle of engaging a collections agency. This proactive software integrates with your revenue cycle to search government and commercial payers automatically, so you can find insurance coverage that may have been missed or forgotten. It relies on multiple data sources and reliable demographic information to detect any inaccurate financial classifications and alternative coverage options. It can also shed light on product usage, productivity and financial results, which may help you fine tune your revenue cycle in other ways. Murry Ford, Director of Revenue at Grady Health System explains how Coverage Discovery allows his team to identify an accurate coverage match for patients without the patient having to share this information: “We use Coverage Discovery when the patient is admitted… the system automatically attaches the coverage to the patient’s account. No one has to get involved – it’s touchless, it’s seamless, and it’s worked really well for us. It’s brought in revenue that we would not have identified otherwise.” Every dollar found in this way is a dollar you’re not writing off to bad debt, or spending on unnecessary patient collections and admin. Mike Simms, Vice President of Revenue Cycle at Cone Health says: “Coverage Discovery is wonderful... After every admission, the next day we get a file which gives us insurance on those that we’ve missed. We can add that insurance to the patient account and bill the insurance company. In the end it helps us resolve accounts in a timely manner. Since we’ve been using Coverage Discovery, we’ve received over $3 million in payments, and that’s more than a 300% ROI.” An automated solution like this can be plugged in immediately to handle unresolved accounts for you, resulting in faster and more accurate collections, greater patient satisfaction, and improved staff workflow – ultimately reducing your organization’s risk of uncompensated care. Learn more about how Coverage Discovery Manager works.
To avoid Civil Monetary Penalty (CMP) liability, health care entities need to routinely check the LEIE to ensure that new hires and current employees are not on Office of the Inspector General’s (OIG) excluded list. Mandatory exclusions: OIG is required by law to exclude from participation in all Federal health care programs individuals and entities convicted of the following types of criminal offenses: Medicare or Medicaid fraud, as well as any other offenses related to the delivery of items or services under Medicare, Medicaid, SCHIP, or other State health care programs; patient abuse or neglect; felony convictions for other health care-related fraud, theft, or other financial misconduct; and felony convictions relating to unlawful manufacture, distribution, prescription, or dispensing of controlled substances The effects of an exclusion are outlined in the Updated Special Advisory Bulletin on the Effect of Exclusions From Participation in Federal Health Programs, but the primary effect is that no payment will be provided for any items or services furnished, ordered, or prescribed by an excluded individual or entity. This includes Medicare, Medicaid, and all other Federal plans and programs that provide health benefits funded directly or indirectly by the United States (other than the Federal Employees Health Benefits Plan), but the primary effect is that no payment will be provided for any items or services furnished, ordered, or prescribed by an excluded individual or entity. This includes Medicare, Medicaid, and all other Federal plans and programs that provide health benefits funded directly or indirectly by the United States (other than the Federal Employees Health Benefits Plan. Search individuals in the Exclusions Database: https://exclusions.oig.hhs.gov/ Review the Updated Special Advisory Bulletin: https://oig.hhs.gov/exclusions/files/sab-05092013.pdf
Most Defendants Charged and Largest Alleged Loss Amount in Strike Force History 6/22/16 Attorney General Loretta E. Lynch and Department of Health and Human Services (HHS) Secretary Sylvia Mathews Burwell announced today an unprecedented nationwide sweep led by the Medicare Fraud Strike Force in 36 federal districts, resulting in criminal and civil charges against 301 individuals, including 61 doctors, nurses and other licensed medical professionals, for their alleged participation in health care fraud schemes involving approximately $900 million in false billings. Twenty-three state Medicaid Fraud Control Units also participated in today’s arrests. In addition, the HHS Centers for Medicare & Medicaid Services (CMS) is suspending payment to a number of providers using its suspension authority provided in the Affordable Care Act. This coordinated takedown is the largest in history, both in terms of the number of defendants charged and loss amount. Attorney General Lynch and Secretary Burwell were joined in the announcement by Assistant Attorney General Leslie R. Caldwell of the Justice Department’s Criminal Division, FBI Associate Deputy Director David Bowdich, Inspector General Daniel Levinson of the HHS Office of Inspector General (OIG), Acting Director Dermot O’Reilly of the Defense Criminal Investigative Service (DCIS), and Deputy Administrator and Director of CMS Center for Program Integrity Shantanu Agrawal M.D. The defendants announced today are charged with various health care fraud-related crimes, including conspiracy to commit health care fraud, violations of the anti-kickback statutes, money laundering and aggravated identity theft. The charges are based on a variety of alleged fraud schemes involving various medical treatments and services, including home health care, psychotherapy, physical and occupational therapy, durable medical equipment (DME) and prescription drugs. More than 60 of the defendants arrested are charged with fraud related to the Medicare prescription drug benefit program known as Part D, which is the fastest-growing component of the Medicare program overall. “As this takedown should make clear, health care fraud is not an abstract violation or benign offense – It is a serious crime,” said Attorney General Lynch. “The wrongdoers that we pursue in these operations seek to use public funds for private enrichment. They target real people – many of them in need of significant medical care. They promise effective cures and therapies, but they provide none. Above all, they abuse basic bonds of trust – between doctor and patient; between pharmacist and doctor; between taxpayer and government – and pervert them to their own ends. The Department of Justice is determined to continue working to ensure that the American people know that their health care system works for them – and them alone.” “Millions of seniors depend on Medicare for essential health coverage, and our action shows that this administration remains committed to cracking down on individuals who try to defraud the program,” said Secretary Burwell. “We are continuing to put new tools and additional resources to work, including $350 million from the Affordable Care Act, for health care fraud prevention and enforcement efforts. Thanks to the hard work of the Medicare Fraud Strike Force, we are making progress in addressing and deterring fraud and delivering results to help ensure Medicare remains strong for years to come.” According to court documents, the defendants allegedly participated in schemes to submit claims to Medicare and Medicaid for treatments that were medically unnecessary and often never provided. In many cases, patient recruiters, Medicare beneficiaries and other co-conspirators were allegedly paid cash kickbacks in return for supplying beneficiary information to providers, so that the providers could then submit fraudulent bills to Medicare for services that were medically unnecessary or never performed. Collectively, the doctors, nurses, licensed medical professionals, health care company owners and others charged are accused of submitting a total of approximately $900 million in fraudulent billing. “The Medicare Fraud Strike Force is a model of 21st-Century data-driven law enforcement, and it has had a remarkable impact on health care fraud across the country,” said Assistant Attorney General Caldwell. “As the cases announced today demonstrate, the Strike Force’s strategic approach keeps us a step ahead of emerging fraud trends, including drug diversion, and fraud involving compounded medications and hospice care.” “These criminals target the most vulnerable in our society by taking money away from the care of the elderly, children and disabled,” said Associate Deputy Director Bowdich. “The FBI is committed to working with our partners and the public to stop fraud and ensure that healthcare dollars are used to help the sick, and not line the pockets of criminals.” “While it is impossible to accurately pinpoint the true cost of fraud in federal health care programs, fraud is a significant threat to the programs’ stability and endangers access to health care services for millions of Americans,” said Inspector General Levinson. “As members of the joint Strike Force, OIG will continue to play a vital role in tracking down these criminals and seeing that justice is done.” “DCIS, in partnership with our fellow federal investigative agencies, will continue to uncompromisingly investigate and bring to justice the people who perpetrate these criminal acts,” said Acting Director O’Reilly. “Their actions threaten to cripple our vital national health care industry, and place our citizenry at risk. We will remain vigilant.” “Taxpayers and Congress provided CMS with resources to adopt powerful monitoring systems that fight fraud, safeguard program dollars, and protect Medicare and Medicaid,” said Deputy Administrator and Center for Program Integrity Director Agrawal. “The diligent use of innovative data analytic systems has contributed or led directly to many of the law enforcement cases presented here today. CMS is committed to its collaboration with these agencies to keep federally-funded health care programs safe and strong for all Americans.” The Medicare Fraud Strike Force operations are part of the Health Care Fraud Prevention & Enforcement Action Team (HEAT), a joint initiative announced in May 2009 between the Department of Justice and HHS to focus their efforts to prevent and deter fraud and enforce current anti-fraud laws around the country. The Medicare Fraud Strike Force operates in nine locations and since its inception in March 2007 has charged over 2,900 defendants who collectively have falsely billed the Medicare program for over $8.9 billion. Including today’s enforcement actions, nearly 1,200 individuals have been charged in national takedown operations, which have involved more than $3.4 billion in fraudulent billings. Today’s announcement marks the second time that districts outside of Strike Force locations participated in a national takedown, and they accounted for 82 defendants charged in this takedown. Source: www.justice.gov