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US Attorney's office sees uptick in health care fraud cases
GRAND RAPIDS, Mich. (NEWSCHANNEL 3) - We're all paying for it with tax dollars and rising insurance premiums.
Experts say health care fraud is on the rise here in West Michigan.
The U.S. Attorney's Office in our district told Newschannel 3 that it's overflowing with cases.
As Newschannel 3 learned, there are several ways this can affect the everyday person.
For one, whistle blowers can earn big bucks in the form of treble damages--three times the amount of actual damages--in health care fraud cases.
In fiscal year 2012, the Department of Justice recovered $3 billion of taxpayer money by cracking down on health care fraud.
"Taxpayers are definitely the ultimate victim here, and that means everyone is suffering when people are abusing the system," said U.S. Attorney Pat Miles.
We're told that schemes that started in Miami and moved to Detroit have now migrated to West Michigan.
Experts call the increase over the last two years "staggering," pointing specifically to a rise in so-called kickback cases.
Ray Beckering, a criminal health care fraud coordinator, describes the cases as, "individuals who are paying physicians, paying other people to refer patients for services much of which are often unnecessary."
The U.S. Attorney's Office recently convicted these nine people--eight of them in federal court--in a statewide fraud.
Fraud also includes billing for services not provided and upcoding.
"In a lot of cases, we're seeing patients being offered free medical equipment, free services, free prescription drugs," described Adam Townshend, a civil health care fraud coordinator. "By waiving the co-pay and providing services free of charge to the patient they know the patient's not going to be asking any questions."
Experts say if it sounds too good to be true, it likely is, and our insurance premiums and federal programs absorb the cost.
The Michigan Medicare/Medicaid Assistance Program can help people understand their bill and report suspected fraud.
You can check out their website by clicking here.