A pair of New Orleans healthcare workers pleaded guilty to defrauding Medicare for $50 million in the latest fraud scheme to pilfer the federal healthcare program to be uncovered by government investigators.
Paige Okpalobi, owner of a Louisiana medical clinic, and her accountant, Christopher White, billed Medicare for home healthcare services that weren’t necessary or were never even provided, according to the Justice Department.
Okpalobi employed doctors who falsely certified the clinic’s Medicare-eligible patients as being homebound and in need of such treatments, then used home healthcare companies she and a co-conspirator operated to bill the government fraudulently for the unneeded care, authorities said.
White admitted in his plea agreement to managing the finances of Okpalobi’s companies and to paying patient recruiters who illegally sold her Medicare beneficiaries’ information so she could file claims for the phantom treatments on their behalf.
Including Okpalobi and White, eight individuals have pleaded guilty to participating in the scheme. A total of 13 people have been indicted, the Justice Department said. Their case is just one of the hundreds that the Departments of Justice and Health and Human Services must probe every year as healthcare fraud rises.
In 2014, the federal government recovered $3.3 billion from such fraud cases, HHS and the Justice Department said in a joint report March 19.
That year, the Justice Department opened 924 criminal healthcare fraud investigations and ultimately won criminal convictions against 734 defendants who had raided government health programs.
The Medicare Fraud Strike Force, a joint effort between the agencies aimed at stemming the flow of fraud losses from Medicare specifically, helped put 248 convicted fraudsters behind bars in 2014.
Since its inception in 2007, the strike force has secured charges against thousands of suspects who together drained $6.5 billion from Medicare.
Rep. Peter Roskam, R-Ill., chairman of the House Ways and Means Oversight Subcommittee, decried the “serious, evolving threat” of Medicare fraud during a hearing Tuesday.
Roskam noted that, of the $124.7 billion the federal government lost to improper payments across more than 100 programs last year, Medicare alone accounted for nearly half the losses.
“Time and again we have seen fraudsters bilk the system for a few million dollars, shut down, and pop up under a new name to run their scams all over again,” Roskam said. “The Medicare program is getting outsmarted by these methods and the proof is in the unacceptably high rate of improper payments each year.”
Roskam had suggested installing a predictive analytics system at HHS to identify and crack down on Medicare fraud before the program pays out on false claims, but he said the system presently pinpoints less than 1 percent of improper payments.
Instead, he said the agency “is still primarily relying on the pay-and-chase model to go after money that has already been paid out improperly, rather than stopping improper payments on the front end.”
