FBI Recoups $2 Billion in Health Care Fraud Money

WASHINGTON–The Federal Bureau of Investigation recovered more
than $2 billion in fraudulent health care monies for the fiscal
year ending Sept. 30, 2006, according to its annual report,
released last week.

In its “Federal Crimes Report to the Public,” the FBI said the
final tally included $373 million in restitutions, $1.6 billion in
recoveries, $172.9 million in fines and $24.3 million in seizures.
The agency said it investigated 2,423 cases of alleged health care
fraud during the year, resulting in 588 indictments and 534
convictions. Many cases are awaiting plea agreements and trials,
the agency said.

The most common schemes included billing for more services or
equipment than was actually provided (known as “upcoding”), filing
duplicate claims, kickbacks and providing unnecessary medical
services. Such activities were not confined to any one sector in
health care, according to the report.

“Throughout the country, various field offices have conducted
their own initiatives targeting clinic, pharmacy, medical
equipment, home health agency, cosmetic surgery center and other
frauds,” the report said.

The report also said the FBI had identified organized criminal
activity in a variety of health care sectors, including durable
medical equipment companies.