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Feds launch medicare anti fraud system

Posted on July 11, 2011 12:00 AM EST

Federal officials finally launched the long awaited computer system to combat Medicare fraud. South Florida has been declared "ground zero" for Medicare fraud. A federal task force operating out of Miramar, Florida was the first to use the new program. For the last couple of years, the federal government has spent large sums of money and man hours to combat the crime. Numerous defendants have been sentenced to multi-year prison terms despite the efforts of the Miami criminal defense lawyers representing them. While in the past, the system used to detect and prosecute Medicare fraud has been mainly reactive, the new computer system definitely reflects a more pro-active approach to fighting the offense. While the use of the program began in South Florida, the system is being used nationwide to prevent the theft of millions of dollars from the federal healthcare program.

The new federal system is called "predictive modeling" and is designed to examine millions of Medicare claims filed on a daily basis. The program looks for suspicious claims to prevent fraudsters from using recruited patients or in the alternative using stolen Medicare identification numbers. According to Peter Budetti, the man leading the initiative, the new system will help identify similar scams occurring across the country. The new anti-fraud system is being used by all Medicare fraud task forces, some of which are set up in Miami, Detroit, Houston and Los Angeles. With all that being said, the federal government will continue to apply pressure to all those involved in healthcare schemes to defraud.

Federal investigators, last month, charged 21 defendants accused of stealing $21 million from the federal government. Six of the defendants are from the Miami area while the remainder were operating out of Michigan. Over the past year, South Florida prosecutors have charged in excess of 102 defendants with billing the federal government $441 million in fraudulent claims. Since 2007, the Medicare strike forces have been involved in the arrest in excess of 1,000 individuals responsible for filing $2.3 billion in fraudulent claims. South Florida led the way with $1.85 billion in fake claims. While it is not clear how much has been lost to fraud, estimates have reached as high as $60 billion. The new system of detection is designed to prevent the fraud from occurring while the old system was used to detect it after the fraud had already been committed.

Being investigated for or charged with Medicare fraud is a serious matter. The federal sentencing guidelines take into consideration the amount of loss in determining a potential sentence. The offense of fraud itself is only a level 6 offense. The problems lie with the multi-level increases that occur when substantial losses to federal healthcare system occurred. The cases prosecuted by the federal government are complex and indictments usually contain dozens of defendants. The defense of these types of cases should not be taken lightly and only qualified defense attorneys with experience in the arena should be retained to represent clients charged with this offense.

Medicare Anti-Fraud System Launched, Orlando Sentinal.com, July 11, 2011.

Categories: Fraud