HEALTH CARE FRAUD
Protecting Your Pocketbook
07/20/07
 |
| Ken
Kaiser, Assistant Director of our
Criminal Investigative Division,
briefs reporters. |
|
"A
billion here, a billion there, and pretty
soon you're talking real money," the
late Senator Everett Dirksen is supposed to
have said.*
And
so it is today with health care fraud,
a burgeoning crime plague that's adding up
in a big way, big-ticket scheme after big-ticket
scheme, essentially costing you money every
time you walk into a hospital or doctor's
office or fill a prescription, whether you
know it or not. The National Health Care Anti-Fraud
Association estimates that this fraud collectively
costs Americans between $60 billion and $100
billion a year. Ouch.
Our
role in combating the problem? We're the
primary investigative agency, with jurisdiction
over federal programs like Medicare and Medicaid
(both big targets) and private insurance programs,
all the while working hand-in-hand with plenty
of public and private sector partners. Locally,
our agents team up with their investigative
counterparts on health care fraud working
groups, task forces, and strike teams to tackle
the biggest scams. Nationally, we have a Health
Care Fraud unit at FBI Headquarters that helps
support and coordinate field investigations
and leads field-wide initiatives.
An
anniversary, of sorts. It was 15 years
ago, actually, that we ran our first major
health care fraud investigation—"Operation
Gold Pill." It involved about a thousand
"professional patients" getting
prescriptions for medicine they didn't need
and having them filled at pharmacies that
 |
| Joe
Ford, Associate Deputy Director
(left), and Sal Hernandez, Deputy
Assistant Director in our Criminal
Investigative Division, at the briefing. |
|
billed Medicare for much more than the cost.
The patients then sold the medication at a
discount
to dealers, who turned around and hawked it
on the street or repackaged it and sold it
back to the pharmacies—a full circle
of crime.
Fifteen
years ago this month, as the investigation
came to a head, hundreds of FBI agents and
other law enforcement professionals fanned
out across the nation, making more than a
100 arrests and seizing more than $30 million
in cash and assets. By today's standards,
that's pocket change. But soon, more resources
came our way, and we were in the business
of busting healthcare fraud full-time.
A
million ways.... Today, the schemes are
more complex, more time-consuming, and more
costly than ever. "There's literally
millions of ways to defraud health care,"
our Associate Deputy Director Joseph L. Ford
told reporters this week. "They come
up with new ways every day." Just a very
few examples of what we see:
Your
role. As with any white-collar fraud,
we depend on alert and conscientious citizens
for help. We encourage you to contact
us if you come across any suspected abuse—either
on the job or in your own personal lives.
Please do yourself a favor and keep an eye
on your explanation of benefits to make sure
you're not getting billed for services or
items you never received. And please safeguard
your insurance card—and your patient
information—just like you would a credit
card. It's fodder for identity thieves, as
well.
For
more telling details on health care fraud,
see our recent Financial
Crime Report. And visit our Be
Crime Smart webpage to arm yourselves
with more facts about the latest scams and
frauds.
*
- The Dirksen Congressional Center questions
whether he ever said this or anything similar;
see its website for details. But it's such
a good quote!
