Multi-Billion Dollar Medicare Fraud Scheme Targets Seniors
Phone Scam Targets Seniors in South Florida
Investigators from the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG) have uncovered a massive fraud scheme targeting seniors who rely on Medicare services. The scheme involves telemarketing companies contacting Medicare recipients, convincing them to undergo unnecessary genetic testing for heart issues or cancer, and then billing Medicare for the tests.
A Recorded Phone Call
A recorded phone call provided by federal investigators shows how the fraud scheme works. The call begins with a telemarketer identifying herself as working with "lab services" and asking an 84-year-old man if he received a FedEx package that was previously sent to him.
The Scam
The man, who is skeptical, responds, "I didn’t order it, but I got it." The telemarketer tries to convince him to take a genetic test for heart issues, claiming it will help identify if he is at high risk for certain illnesses. The man is not convinced, but a supervisor gets on the phone to try to persuade him to take the test.
How the Scheme Works
The scheme begins when telemarketing companies contact Medicare recipients using illegally obtained personal data. They claim to be working with Medicare and try to convince them to take advantage of a benefit or service. The companies then get doctors or other providers to sign off on the unnecessary genetic testing, usually for cancer or heart conditions. A shell lab then bills Medicare for the worthless test, and everyone involved gets a cut.
The Cost of the Fraud
The cost of this fraud is staggering. According to the data, genetic testing fraud is responsible for about $7 billion in fraud from 2018 to present. Despite this, only about 2 cents of every $100 spent by Health and Human Services goes to oversight and enforcement, prompting the agency to ask for additional funding this year.
Law Enforcement Efforts
The HHS-OIG works with state and federal partners to crack down on these crimes. The Miami office of the HHS-OIG has a health care fraud strike force, which is the largest in the country. Several people have been charged in connection with the Boca Raton call center, including brothers Daniel and Louis "Gino" Carver, who pleaded guilty to submitting over $67 million in false claims for genetic testing and durable medical equipment.
Conclusion
The multi-billion dollar fraud scheme targeting seniors is a serious concern, and law enforcement agencies are working to crack down on these crimes. The cost of the fraud is staggering, and it is essential to ensure that those responsible for it are held accountable. The public is urged to be vigilant and report any suspicious activity to the authorities.
FAQs
Q: How does the fraud scheme work?
A: Telemarketing companies contact Medicare recipients using illegally obtained personal data, convincing them to take unnecessary genetic tests for heart issues or cancer. They then get doctors or other providers to sign off on the tests and bill Medicare for the worthless tests.
Q: How much has the fraud scheme cost?
A: Genetic testing fraud is responsible for about $7 billion in fraud from 2018 to present.
Q: What is being done to combat the fraud?
A: The HHS-OIG works with state and federal partners to crack down on these crimes. The Miami office of the HHS-OIG has a health care fraud strike force, which is the largest in the country. Several people have been charged in connection with the Boca Raton call center.
