What is Medicare & Medicaid fraud?

Learn about the most common ways that companies and individuals defraud the US government healthcare programs.

 

Who can become a Medicare & Medicaid whistleblower?

Do you have information about Medicare or Medicaid fraud? Find out if you can become a healthcare fraud whistleblower and receive a financial reward.

Receiving a financial reward.

Medicare & Medicaid whistleblowers may be entitled to a significant financial reward for coming forward. Learn about receiving a financial reward for your information here.

Medicaid Fraud News

In a press release, the U.S. Department of Justice (DOJ) indicated that a Pennsylvania-based supplier, along with its former owners, paid the U.S. in excess of $4 million today to settle allegation of Medicare fraud, amounting to millions of dollars. The charges result from the principals’ filing of false claims for reimbursement.

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Brooklyn man pleads guilty to a Medicare fraud scheme
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The United States Department of Justice in an October 22, 2010 press release reported that a Brooklyn man, Yefin Drakhler, pleaded guilty to a Medicare fraud scheme.

The case involved a Brooklyn clinic, Solstice Wellness Center, “purportedly providing physical and therapy and various diagnostic services” according to the release.

Drakhler, 74, was said to conspire to solicit and receive kickbacks in the form of cash in return for “purportedly receiving treatment at Solstice.” He was a Medicare patient at the center and received cash for receiving the treatments.

According to the release, a former medical worker at the clinic showed law enforcement authorities the clinic’s books, which contained names of Medicare beneficiaries. Drakhler’s name was in the book.

Drakhler confessed that for 15 months, from January 2009 to April, 2010, when he made visits to Solstice for treatment that he was paid cash to receive those treatments. He said a man he identified as one of the owners was the one who gave him the payments.

The DOJ labeled Drakhler an “over-utilized beneficiary”, or a person who is shared among providers and receives an “excessive volume” of services. The complaint said Drakhler received $214,516 worth of services from over 100 providers during a six-year timeframe.

Although a sentencing date has not yet been set, Drakhler faces a maximum of five years in prison as well as a fine of $250,000.

The federal government takes false billing and Medicaid fraud cases seriously and vigorously pursues lawbreakers. Since its March 2007 inception, the Medicare Fraud Strike Force, operating in seven districts, has indicted more than 800 persons. Their false billings to the Medicare program exceed $2 billion.

The Health Care Fraud Prevention and Enforcement Action Team (HEAT) is comprised of fraud prevention teams out of the Health and Human Services branch. They are charged with identifying, charging, and prosecuting fraudulent providers.

Have information on Medicaid Fraud?

If you have information about Medicaid fraud, contact the Medicaid Fraud Reporting Center for a confidential claim evaluation today. You may report Medicaid fraud by completing the form on this page, or by calling our Medicaid Fraud Hotline at 1-800-934-2921.