Medicare and Medicaid Fraud; Lazy Agents and "Lazy Math"

The United States Attorney's Office for the Northern District of Georgia has recently announced the federal indictment of George and Rhonda Houser, owners of nursing homes in Rome and Brunswick, Georgia. The husband and wife defendants reportedly face various federal criminal charges, including $30 million in alleged Medicare and Medicaid fraud. Of course, an indictment is only a charge and the Housers are presumed innocent, unless and until proven guilty in a court of law. But this post isn't about that particular case, anyway.

Instead, this post is about the bad practices of some, (a few), lazy federal agents. As a former federal prosecutor, (and currently, as an Augusta, Georgia criminal defense lawyer), I have seen that, in some federal criminal cases, government agents will attempt to cut corners in their investigations by finding a few examples of mistakes, or false billings. Then, based upon these few examples of false billings, these agents will unfairly extrapolate, based upon how long the suspects have been in business, and contend that the (potential) fraud must be much larger. In other words, these federal agents are too lazy to fully investigate and ferret out ALL the potential fraud. Instead, they take the easy way out, through guess work, and simply claim the fraud case is bigger than it really is!

Again, no one is claiming this occurred in the Houser investigation. I know absolutely nothing about that case other than what is in the news. But, in my opinion, such extrapolating and "lazy math" have occurred in at least some other federal criminal cases! So, please watch out for those lazy agents and their "lazy math!"

The Mafia and Medicare Fraud

Have you heard the news this week? The mafia is reportedly moving into the Medicare fraud racket! As if Medicare fraud wasn't already bad enough, now organized crime is reportedly trying to get a piece of the action!

Medicare fraud has indeed already been a major problem in this country. Now, it is just going to get worse. While there appear to be no reliable statistics, according to Wikipedia, of the $368 billion spent on Medicare billings, (for the elderly), each year, approximately 20% of the billings are fraudulent! Folks, that's over $73 billion per year in health care fraud in this country!

As a former federal prosecutor, in my opinion, part of the problem lies in the fact that Congress does not appropriate sufficient funds for law enforcement to combat Medicare fraud. According to Wikipedia, right now, the F.B.I. alone has open over 2,400 open health care fraud investigations. There simply are not enough agents and prosecutors solely dedicated to combatting this problem.

Moreover, in my opinion, some of the investigations are ill-conceived and improperly focus on legitimate medical doctors, hospitals, and other health care facilities that simply make billing mistakes. The government's focus should be on the real crooks.

And now, if things weren't already bad enough, the mafia is getting into the action! Wow! Sometimes, such bad news makes you wonder if things aren't just all going to Hell in a handbasket, doesn't it?!