The San Juan Daily Star
Feds vow to double down on Medicare fraud detection & deterrence
By The Star Staff
Federal authorities on the island announced Wednesday that they are redoubling efforts and focus to investigate, detect and deter Medicare fraud.
According to estimates from the National Health Care Anti-Fraud Association, Medicare fraud costs taxpayers over $100 billion a year in a wide range of fraud schemes that involve beneficiaries, health care providers, and organizations operating Medicare Advantage (Medicare Part C) plans. All Medicare beneficiaries in Puerto Rico, as well as the doctors and other healthcare providers who serve those beneficiaries, deserve an affordable, effective, efficient, and transparent health care system, the officials -- United States Attorney for the District of Puerto Rico W. Stephen Muldrow, Special Agent in Charge of the FBI’s San Juan Office Joseph González, and Assistant Special Agent in Charge (ASAC) of the U.S. Department of Health and Human Services Office of the Inspector General (HHS-OIG) José Luis Soto -- said in a written statement.
In October of last year, seven individuals were arrested for fraud related to Social Security and Medicare in Puerto Rico that surpassed $1 million.
“Typical fraud schemes committed in the health care area include cases where healthcare providers bill for services not actually provided or lie about and inflate the nature of the actual services rendered (known as “upcoding”),” Muldrow said. “However, together with our law enforcement partners, our investigative and prosecutorial focus will continue to look at any fraudulent activities occurring within organizations managing Medicare Advantage programs, including payments of illegal incentives and the submission of false information related to patient risk assessments.”
González noted that “[h]ealthcare is a basic need and improper use of healthcare systems can turn this basic necessity into a luxury.”
“The FBI will not stand by while this type of abuse is taking place,” he said. “We ask that anyone who believes they have been a victim or witness to a healthcare fraud scheme to report it by calling the FBI San Juan number 787-987-6500 or leave a tip online through tips.FBI.gov.”
Soto, the HHS-OIG ASAC in Puerto Rico, added that “HHS-OIG will continue to investigate any conduct by Medicare Advantage plans that may result in violation of federal law and will work jointly with our law enforcement partners to ensure that entities that execute business with federal health care programs do so in an honest manner.”