HHS and OIG Announce Largest Healthcare Fraud Bust Ever

The US Department of Health and Human Services (HHS) announced its largest ever healthcare fraud sting in mid-July, when it charged 412 individuals over a total of $1.3 billion in false billings to Medicare and Medicaid. According to the announcement by HHS’ Office of the Inspector general (OIG), the agency also issued exclusion notices to 57 doctors, 162 nurses, and 36 pharmacists.

“This year’s takedown features a large-scale federal and state partnership to combat health care fraud and the opioid epidemic,” according to a fact sheet OIG issued about the raid. “Enforcement activities took place nationwide, from Washington to Puerto Rico. This multi-agency enforcement operation is the largest in history, both in terms of the number of defendants charged and loss amount.”

One of the fraud cases uncovered in this sweep included the case of a physician in Texas charged with allegedly overprescribing medically unnecessary narcotics to patients, some of whom died from drug overdoses. The doctor allegedly fraudulently billed Medicare and received more than $1.2 million in reimbursement, according to OIG.

Another fraud scheme in Michigan led to the arrest of seven defendants, including five physicians that allegedly participated in “illegal kickbacks and billing for medically unnecessary joint injections, drug screenings, and home health services. One of the defendants owned multiple medical and health-related businesses, and these businesses allegedly fraudulently billed Medicare $126 million as part of the scheme,” OIG stated in its fact sheet.

Tips for Detecting Fraud

Having solid coding compliance practices and data analytics programs can help healthcare providers root out fraud perpetrated by improper billing and coding practices, Bill Bithoney, senior fellow at BDO Center for Healthcare Excellence and Innovation, told the publication Healthcare Dive.

He said to look out for coding irregularities such coding that indicates that a man is pregnant, as well as a large billing set of patient admissions in an area with a declining population rate, according to Healthcare Dive.


Mary Butler is the associate editor at The Journal of AHIMA.

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