Mr. Tim Menke, the deputy inspector general for investigations at the US Department of Health and Human Services, speaks about how organized crime and street gangs have been getting in on health care fraud.
“A crime that is very common is the setting up of a phoney billing system with a home health agency.”
How big is Medicare and Medicaid fraud in the country? Mr. Menke says, “Roughly $60 billion a year, and we recover about $4 billion a year. It's lucrative and it's safe. Why rob a bank and risk getting shot when you can click a mouse and bill Medicare or Medicaid, basically lie on some forms and make millions of dollars doing so.
“There is a sheer level of fraud that we're seeing, the audacity, the violence. I think we're a little concerned because of some of the things we're finding on search warrants. Historically, we've taken boxes of paper in a typical fraud investigation. Now, because of the organized crime and street gang influence, we're taking machine guns, automatic weapons, out of facilities that are engaged in health fraud. That's a little disturbing for me. I have roughly 500 special agents assigned to work this health care fraud and it puts a whole new spin on things. It's not the traditional white collar fraud that we were working five years ago. It's getting edgier and more dangerous.”