Latest news with #MedicareFraud
CBS News
7 hours ago
- Business
- CBS News
11 charged in major Medicare fraud bust, including Brooklyn business owner
Federal prosecutors in Brooklyn have now charged 11 people in one of the largest Medicare fraud busts in history, including the owner of a local business. CBS News New York first reported on the man and a slew of connected Medicare fraud complaints last year. Brooklyn business collects taxpayer dollars through alleged Medicare fraud In February 2024, CBS News New York investigative reporter Tim McNicholas went looking for the owner of G&I Ortho Supply in Gravesend. Dozens of Better Business Bureau complaints revealed G&I was collecting taxpayer dollars for catheters under the names of Medicare members who never requested them. The search led McNicholas to Staten Island, where one man said he'd recently sold the company to another man who was allegedly using a fake Texas ID. However, prosecutors said the name the buyer used was real: Kevin Valdhans. A second man — Jonathan Vaz, of Fort Lauderdale — said Valdhans also bought his company, but didn't remove him from their billing system after the sale. Vaz said at the time, he saw that Valdhans had billed about $7 million worth of catheters in just one week. Suspects received $41 million from Medicare, investigators say A federal indictment unsealed Thursday says Valdhans was part of a criminal organization based in Eastern Europe that bought more than 30 legitimate companies, then used them for Medicare fraud. Prosecutors say the group's leader was based in "Russia and elsewhere." Eight of the people charged are Estonian citizens, one is a United States citizen, and Valdhans is from the Czech Republic. The indictment accuses the group of "stealing the identities and personal identifying information of more than 1 million Americans." Investigators say the group submitted $10 billion worth of bogus Medicare claims and actually received $41 million from Medicare, plus $900 million from Medicare Supplemental Insurers. Prosecutors say the operation lasted until September. Similar fraud complaints at Queens-based business A Queens business has also been connected to Medicare fraud complaints, but that medical supply shop is not mentioned in the indictment. Some of the claims connected to that business were submitted as recently as this month. As far as we know, there is no direct connection between that business and the Russia-based organization, but it is a similar pattern in the sense that a man said he recently sold the Queens business and then started learning of fraud complaints.
Health Line
9 hours ago
- Health
- Health Line
How to Identify and Report Medicare Fraud
Medicare fraud is when a person knowingly submits false information or misuses the Medicare system to achieve personal financial gain or to receive benefits for which they are ineligible. Medicare has numerous official channels for reporting suspected fraud. While estimates vary, the Senior Medicare Patrol reports that Medicare losses due to fraud could be as high as $60 billion annually. What's clear is that Medicare fraud and abuse are pervasive, put significant stress on the system, and have the ability to affect the care that older adults receive. Medicare fraud can be perpetrated by various people and organizations, including healthcare providers, such as doctors, clinics, or hospitals, as well as criminal groups and individuals. In this article, we'll discuss what Medicare fraud is, how to identify it, and where to report it. Common types of Medicare fraud Medicare fraud can take many forms and can affect both beneficiaries and providers. Common types of Medicare fraud include: Medical identity theft: This can take many forms. It could involve using another person's Medicare number to obtain healthcare services or benefits or using a physician's identifier to fill prescriptions. Billing for unnecessary services: Under Medicare regulations, many procedures only receive coverage if they're considered medically necessary. If a provider intentionally bills for unnecessary procedures, it is a form of fraud. Kickbacks: Kickbacks are when a provider receives some form of compensation in exchange for referrals or utilization of services. An example would be a doctor who receives personal payment from a lab facility for referring patients. Billing for services never rendered: This is when a provider bills Medicare for services or procedures it never actually administered. It may involve falsifying documentation to create the appearance of authenticity. Upcoding and unbundling of services: Upcoding involves billing for services at a higher complexity than those actually rendered. Unbundling involves submitting bills in a staggered fashion to maximize payment when Medicare requires that those bills be submitted together to reduce costs. Vigilance is important in matters related to Medicare and billing. Understanding what to look for can help you identify fraud in practice. As a consumer and Medicare beneficiary, be sure to regularly check your Medicare claims and keep an eye out for irregularities. Look for: unfamiliar charges on your Medicare summary notice line items for services you didn't receive bills from unfamiliar providers If you have regular contact with a healthcare professional, facility, or other provider, you may notice trends that could signal potential fraud. These include: unusual billing patterns geographic anomalies suspicious documentation patient complaints How to report Medicare fraud If you suspect fraud may be occurring with a given provider, it's important to notify the Centers for Medicare & Medicaid Services (CMS). Reporting suspected fraud, waste, or abuse in Medicare programs is key to protecting both the integrity of the Medicare system and the individuals it serves. You can do this in various ways: Contact Medicare by phone at 800-MEDICARE (800-633-4227). Submit a complaint online with the Office of Inspector General of the Department of Health and Human Services (HSS-OIG). Contact the HSS-OIG by phone at 800-HHS-TIPS (800-447-8477). Individuals with a private Medicare plan, such as a Medicare Advantage (Part C) or Part D plan, can also reach out to the Investigations Medicare Drug Integrity Contractor (I-MEDIC) with fraud complaints. You can reach I-MEDIC by phone at 877-772-3379. Before filing a complaint, it's important to collect all relevant documentation to back up your claim. This includes: your Medicare number the subject of your complaint, including information that can identify them the service in question and the date of receipt the cost of the service Summary Fraud and abuse cost Medicare billions of dollars each year. Reporting Medicare fraud is important for protecting individuals and maintaining the integrity of the Medicare system. Always guard your Medicare card, number, and other personal medical information. Additionally, review your Medicare summary notices routinely for irregularities that suggest inappropriate billing. If you think you were billed incorrectly, consider contacting Medicare for clarification. While errors happen, and not all errors are due to fraud, it's best to be safe and report your concerns. The information on this website may assist you in making personal decisions about insurance, but it is not intended to provide advice regarding the purchase or use of any insurance or insurance products. Healthline Media does not transact the business of insurance in any manner and is not licensed as an insurance company or producer in any U.S. jurisdiction. Healthline Media does not recommend or endorse any third parties that may transact the business of insurance.
New York Times
11 hours ago
- Health
- New York Times
U.S. Charges 11 in Russia-Based Scheme to Bilk Medicare of $10.6 Billion
When hundreds of thousands of Medicare recipients were billed for expensive medical equipment they never asked for in 2023, doctors and health care providers around the United States feared a far-reaching fraud. Those fears were well-founded, federal prosecutors say. The surge in Medicare claims, for urinary catheters, braces and other durable medical equipment, was part of one the largest schemes ever designed to defraud the program, according to an indictment unsealed in the Eastern District of New York this week. The indictment charges 11 citizens of the United States, Estonia and the Czech Republic with working for a criminal organization based in Russia that, prosecutors say, defrauded Medicare of $10.6 billion. The scheme involved buying dozens of companies that were accredited to submit claims to Medicare and the program's supplemental insurers, prosecutors say. Then, using personal information stolen from more than a million Americans, the defendants filed billions of dollars in claims for equipment that had not been ordered by Medicare beneficiaries and was not delivered to them, according to the indictment. Even if the patients themselves did not pay for the phantom medical supplies, such schemes can affect Medicare recipients by causing premium costs to rise. Want all of The Times? Subscribe.
CBS News
a day ago
- Health
- CBS News
Medicare recipients say Queens-based business is filing bogus claims for unwanted medical supplies
People from across the country say a Queens-based business is charging their Medicare accounts for medical supplies they never ordered or received, yet records show Medicare is coughing up tens of thousands of taxpayer dollars for the bogus claims. CBS News New York investigative reporter Tim McNicholas first uncovered this pattern back in February 2024. Medicare paid NYC store thousands, records show Linda Christensen, Katherine Hensley and Jennye Keefer all say they've never needed anything from Almaz Med Supply on 69th Street and Queens Boulevard. In fact, Keefer and Hensley say they've never even been to Queens, Christensen has never heard of the store, and they all live in different states – Pennsylvania, Florida and Maryland. So imagine their surprise when they discovered Medicare claims in their names for thousands of dollars worth of orders from the store. The women shared account records showing Medicare paid the store $13,000 between March and June, $6,300 between December and April, and a separate $6,300 payment in January. The payments were all for wound dressings, glucose monitors for diabetes and catheters that they say they never received or needed. "If there was a way to notify me and say, 'Hey Mrs. Keefer, sorry to hear about your diabetes,' I would have said, 'What are you talking about?'" Keefer said. "The question that comes into my mind is how did they get my Medicare number and how did this get through?" Hensley said. Claire Rosenzweig, of the Better Business Bureau, says her team has fielded eight other similar complaints about the company since last fall. "All of our personal information unfortunately is out there. And sometimes it's hacked. There's the dark web. There's so many ways that fraudsters can get ahold of personal information," she said. Neighbor says no one ever enters, leaves store State records show Almaz Med Supply is registered to a Zurab Tsotskhalashvili. Someone with that name listed a Brooklyn apartment building as their address last year in an unrelated lawsuit, so McNicholas visited that building. Over the callbox, an individual identified himself as Zurab Tsotskhashvili and let McNicholas into the building, but no one answered the door to the apartment inside. When McNicholas tried the callbox again, the man repeatedly stated "I'm not Rob" and said he knew nothing about Almaz. No one answered the door or the phone at the store. Mohammad Sarder, who lives two doors down, said that doesn't surprise him. "They open probably like three, four years, five years. I'm not sure exactly," he said. Sarder said in that time, he's never seen anyone going in or out of the store. McNicholas also tracked down a man who said he sold Almaz Med Supply to Tsoskhalashvili last year. The man says he started learning about fraud allegations soon after. He would not agree to an on-camera interview and directed us to his attorney, who never returned our calls. Medicare fraud, abuse costs $60 billion per year, feds say Last year, a CBS News New York investigation revealed another New York City business billed Medicare for millions of dollars worth of catheters that patients never requested. That story involved the same pattern: multiple companies that changed management or owners and then had complaints about fraud. The federal government says Medicare fraud, errors and abuse cost the U.S. Department of Health and Human Services $60 billion per year. The Trump administration has repeatedly said it's working to eliminate various types of fraud, but HHS and its secretary, Robert F. Kennedy Jr., didn't respond to CBS News New York's interview request for this story. Neither did Kennedy's predecessor, Xavier Becerra. HHS told us in email last year that they have ways of clawing payments back and, even if a claim publicly shows up as paid, it doesn't necessarily mean the money went out the door — but sometimes it does, hence the annual losses.
Washington Post
a day ago
- Business
- Washington Post
11 Eastern Europeans charged in $10.6 billion Medicare fraud scheme
Federal prosecutors on Thursday unveiled charges against 11 Eastern Europeans they accused of running a sophisticated, $10.6 billion Medicare fraud scheme in what appears to be one of the largest such busts in government history. According to an indictment unsealed in federal court in New York, the group based in Russia and elsewhere submitted billions of dollars in false health-care claims using personal information stolen from more than 1 million Americans in all 50 states. Prosecutors say the organization bought more than 30 previously legitimate U.S. companies and turned them from legitimate businesses into consistent vehicles for fraud.
