Health Care Fraud Unit
The Health Care Fraud Unit operates within the Criminal Division of the United States Attorney's Office for the Western District of Missouri.
Fraud and abuse in the provision of health care services is a problem of national magnitude. It is estimated that the costs to the American public from health care fraud and abuse exceed $1 billion annually. The detection and elimination of health care fraud is a priority with the Department of Justice as well as this office. The United States Attorney works in conjunction with federal, state, and local law enforcement to investigate and prosecute health care fraud. In fiscal year 1999, over $524 million was won or negotiated in connection with health care fraud cases nationally. (This amount does not include monies recovered for Medicaid and private insurance fraud.)
Reporting health care fraud: If you believe that you have information concerning possible health care fraud, please report the information so that the appropriate law enforcement agency can conduct an investigation. It has been our experience that many health care fraud investigations are commenced as a result of a tip provided by concerned citizens.
To report suspected health care fraud in the Medicare program, you may call the Department of Health and Human Services hot line at 1-800-HHS-TIPS (800- 447-8477). If you suspect Medicaid fraud, you may call the Missouri Medicaid Fraud Control Unit at (573) 751-8366. If you suspect private insurance fraud, contact the insurance company.
If you prefer, you may report your concerns to our office. You may call us at (816) 426-4322 or you can mail us your information. We will review any information and refer it on to the appropriate agency.
Current health care fraud issues:
Nursing homes: Health care fraud may be pursued not only when there are financial losses, but also when poor quality care is provided to Medicare and Medicaid recipients in nursing homes. Instances where necessary patient care is not provided, yet the nursing home bills a government program as though care was provided, is on example of such a case. This may constitute fraud because the government ends up paying for care that was not provided in the manner agreed to by the nursing home and required by the government. Quality of care in nursing homes is a priority for the Department of Justice and U.S. Attorney's Offices. To that end, steps have been taken to bring together federal, state and local law enforcement, regulatory, survey and advocacy entities to discuss ways in which to share information to address the concerns with abuse and fraud in nursing homes. As a result of this sharing of information, investigations for fraud relating to quality of care have been initiated.
Exclusion of health care providers: Under federal law, health care providers who have been criminally convicted of health care offenses, including fraud and patient abuse, can be excluded from participating in the Medicare and Medicaid programs. This means that the health care provider cannot bill or receive payments from those programs. There are currently over 15,000 health care providers and entities excluded from participating in government health care programs. Information on exclusions is available at http://hhs.gov.
To contact the Health Care Fraud Unit, call 1-800-733-6558, or locally in Kansas City call 816-426-3122, and ask to speak to Gene Porter, criminal health care fraud coordinator, or Joel May, civil health care fraud coordinator.