National Health Care Fraud Takedown Results in Charges Against 301 Individuals for Approximately $900m in False Billing

Attorney General Loretta E. Lynch and Department of Health and Human Services (HHS) Secretary Sylvia Mathews Burwell announced today an unprecedented nationwide sweep led by the Medicare Fraud Strike Force in 36 federal districts, resulting in criminal and civil charges against 301 individuals, including 61 doctors, nurses and other licensed medical professionals, for their alleged participation in health care fraud schemes involving approximately $900 million in false billings. Twenty-three state Medicaid Fraud Control Units also participated in today’s arrests. In addition, the HHS Centers for Medicare & Medicaid Services (CMS) is suspending payment to a number of providers using its suspension authority provided in the Affordable Care Act. This coordinated takedown is the largest in history, both in terms of the number of defendants charged and loss amount.

Attorney General Lynch and Secretary Burwell were joined in the announcement by Assistant Attorney General Leslie R. Caldwell of the Justice Department’s Criminal Division, FBI Associate Deputy Director David Bowdich, Inspector General Daniel Levinson of the HHS Office of Inspector General (OIG), Acting Director Dermot O’Reilly of the Defense Criminal Investigative Service (DCIS), and Deputy Administrator and Director of CMS Center for Program Integrity Shantanu Agrawal M.D.

The defendants announced today are charged with various health care fraud-related crimes, including conspiracy to commit health care fraud, violations of the anti-kickback statutes, money laundering and aggravated identity theft. The charges are based on a variety of alleged fraud schemes involving various medical treatments and services, including home health care, psychotherapy, physical and occupational therapy, durable medical equipment (DME) and prescription drugs. More than 60 of the defendants arrested are charged with fraud related to the Medicare prescription drug benefit program known as Part D, which is the fastest-growing component of the Medicare program overall.

“As this takedown should make clear, health care fraud is not an abstract violation or benign offense – It is a serious crime,” said Attorney General Lynch. “The wrongdoers that we pursue in these operations seek to use public funds for private enrichment. They target real people – many of them in need of significant medical care. They promise effective cures and therapies, but they provide none. Above all, they abuse basic bonds of trust – between doctor and patient; between pharmacist and doctor; between taxpayer and government – and pervert them to their own ends. The Department of Justice is determined to continue working to ensure that the American people know that their health care system works for them – and them alone.”

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National Health Care Fraud Takedown Results in Charges Against 301 Individuals for Approximately $900m in False Billing

ACA palliative care provisions open new door for probate, property rights abuse

Palliative care is a term with which increased numbers of Americans have become familiar since 2009 with the debate and passage of the Affordable Care Act (ACA). Stated simply, it’s medical care administered as a replacement to medical treatment. It’s also key to the “death panels” Obamacare opponents predict.

Following the June 2012 U.S. Supreme Court decision upholding the new healthcare law, the Center to Advance Palliative Care issued this statement:

The Center to Advance Palliative Care is pleased that the Affordable Care Act, with its aims to expand access to quality healthcare for all Americans, will continue to positively affect healthcare delivery in the United States. With increased access to care, and the development of enhanced quality measures, more seriously ill patients and families will receive the high quality, effective care they need to reduce suffering and live longer, healthier lives. This benefit is of the utmost importance to CAPC and the field of palliative care, as the patients we treat are the sickest, most vulnerable people in our nation’s healthcare system.

A 2009 article, Obamacare: Stimulus for estate abuse?, described how disgruntled family members, wannabe heirs or unscrupulous members of the legal industry will find Obamacare helpful with Involuntary Redistribution of Assets (IRA) actions in which probate venues or instruments like wills, trusts, guardianships and powers of attorney are used to divert assets from intended heirs or beneficiaries. Palliative care was also discussed:

Palliative care, a common end-of-life care component, is defined as any form of medical care or treatment that concentrates on reducing disease symptom severity rather than striving to halt, delay, or reverse progression of the disease itself or provide a cure. The goal is to prevent and relieve suffering and to improve quality of life for people facing serious, complex illness. While used with aggressive treatment, it is also a common alternative for patients who decline prolonged, expensive efforts. Performed under the guise of government-run health care, it’s likely to become a mandated, state-sponsored doping of sick Americans deemed unsuitable for proactive medical treatment. 

Elder financial abuse is frequently termed the crime of the 21st century. Estate looting and other probate abuse often fall into this category. Estate disputes frequently include allegations of undue influence with the role of medication being a common point of contention. If palliative care becomes a major tool in the government’s arsenal of health care cost-cutting measures, predators will seize this opportunity.

These concerns are now bolstered as CNS News reports how the National Institutes of Health (NIH) is “soliciting applications for federal grants worth up to $275,000 to research ways to provide elderly patients with ‘palliative care’ – even in hospital emergency rooms and intensive care units.”
The article explains:

Palliative care is commonly understood to mean medical treatment that focuses on relieving symptoms, including pain, instead of trying to treat or cure the underlying disease. 

But researchers will not be studying the use of palliative care to relieve the suffering of dying patients. “Hospice and end-of-life settings are not included within the scope” of the Funding Opportunity Announcement (FOA), the grant notices specifically state. 

Instead, they will be looking at new ways to provide elderly patients with palliative care long before they are at death’s door. 

The palliative care will be provided in “a variety of settings, including ambulatory care, hospitals (and specific sites within hospitals including specialty wards, intensive care units and emergency departments), assisted living facilities, and short- and long-term care facilities.” 

The federal money will be used to “advance [the] science of geriatric palliative care… in settings and at time points earlier in geriatric patients’ diseases or disability trajectories,” according to the grant notices (PA-13-354, 355 & 356). 

One of the grants is categorized under NIH’s R21 Exploratory/Developmental grants, defined on the agency’s website as “novel studies that break new ground or extend previous discoveries toward new directions or applications.”

“Isolate, medicate, steal the estate” is a phrase commonly associated with IRA acts. The medicate phase offers great opportunity for the use of undue influence that can lead to late-in-life and uncharacteristic estate plan changes. Abandoning proactive medical treatments to artificially incapacitate our seniors in the name of “palliative care” will aid unscrupulous individuals in estate hijacking pursuits. Similar concerns can be raised for the disabled or younger people with terminal illness or life-threatening injuries – especially individuals attached to a significant estate as legal settlements can provide.

The Obama administration and other congressional leaders claim this new system will be better for all Americans. The federal government wants us to trust it with a plan forcing a majority of Americans to forfeit a flawed, but functioning health care system in pursuit of a plan that already is driving up insurance costs, failing to attract the young, healthy people on who its premium structure is based and prompting a move of workers to the plan as employers drop increasingly-expensive coverage.

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ACA palliative care provisions open new door for probate, property rights abuse