Federal agencies are escalating their fight against alleged fraud, waste and abuse in Medicare and Medicaid, deploying funding freezes, new enforcement units and criminal prosecutions.
Here are 10 numbers that define the crackdown.
$2 billion. The amount CMS could withhold annually from Minnesota’s high-risk Medicaid programs, up to $515 million per quarter, announced in January. The state has appealed the action.
$260 million. Medicaid funding CMS froze for Minnesota in February over potentially fraudulent claims. The state sued in March; an assistant state attorney general argued the funds should have been released once the state’s corrective action plan was approved.
$91 million. The additional Medicaid deferral CMS Administrator Mehmet Oz, MD, announced for Minnesota in late April, even as the state moved forward with its corrective action plan.
$1.3 billion. Federal Medicaid reimbursements withheld from California, announced by Vice President J.D. Vance on May 13. Dr. Oz called it the agency’s largest deferral ever.
$10 billion. Social services funding HHS attempted to freeze for California, Minnesota, Colorado, Illinois and New York earlier this year. The states sued and blocked the freeze, and the federal court case remains active.
6,200+. Defendants charged under the broader enforcement model that served as the foundation for the Justice Department’s new West Coast Health Care Fraud Strike Force, launched April 30 and covering Arizona, Nevada and Northern California.
$1.5 billion. In alleged fraudulent billing that CMS said it halted last year from durable medical equipment, prosthetics and orthotics suppliers — a sector flagged as allegedly historically high risk.
Six months. The length of the nationwide freeze CMS imposed May 13 on new Medicare enrollments for hospices and home health agencies. A separate six-month moratorium on some DME, prosthetics and orthotics suppliers had already been established in February.
Eight cases. The number of individual fraud cases Becker’s has tracked in which the Justice Department sentenced, accused or settled with defendants, including four physicians and four DME company owners, since the beginning of the DME moratorium.
$61.5 million. The value of the healthcare fraud conspiracy orchestrated by Robert Smith III of Archer City, Texas. Mr. Smith owned and operated seven DME supply companies that submitted false Medicare claims for medically unnecessary orthotic braces and foot baths, affecting thousands of beneficiaries.
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