The Medicare Fraud Strike Force set a new record this week for the largest takedown against medical professionals attempting to defraud Medicare.
The sweep resulted in criminal and civil charges against 301 individuals across 36 federal districts, including 61 physicians, nurses and other licensed medical professionals for allegedly participating in schemes involving $900 million in false billings.
Jonathan Braunstein, JD, is a partner at Seyfarth Shaw law firm in San Francisco. He specializes in healthcare reimbursement and provider billing litigation, with an emphasis on fraud, waste and abuse. Mr. Braunstein talked to Becker's Hospital Review about his thoughts on the U.S. Department of Justice's takedown.
Note: Responses have been lightly edited for length and clarity.
Question: What were your initial thoughts about the takedown?
Jonathan Braunstein: Takedowns like this have been consistent over the last several years. However, this one is the largest in scope, amount of dollars lost and people charged. This takedown not only reinforces that healthcare fraud is a large-scale epidemic in this country, it also highlights state agencies are focused on the issue, which is a good thing.
Q: There have been numerous government crackdowns on healthcare fraud in recent years. Do you think this trend represents an increase in fraud or an increase in government efforts to control fraud?
JB: Both. Healthcare fraud is rampant in our country right now, causing a huge impact on the overall economy. This most recent takedown was low hanging fruit for the Medicare Fraud Strike Force. In response to this abundance of fraud, Congress is pumping more and more money into the Task Force and getting greater return. Furthermore, the data analytics movement in our country has really helped the Task Force stop fraud.
Q: How has healthcare fraud affected the private insurance industry?
JB: Healthcare fraud is not just a public sector problem. Both government and private insurance companies have a lot of fraud waste and abuse. The government funds the Task Force to reduce fraud and generate more federal revenue. Over time, I think private companies will follow suit and implement more crackdown initiatives.
Q: What kind of preventative measures should be in place to fight fraud?
JB: We're always going to have a problem with healthcare fraud. As long as there is human greed, there will be fraud. Currently, there's a lot of stress on the U.S. healthcare system and a lot of rising costs. Cracking down on fraud helps control cost, and enforcement efforts are going to continue into the future.