U.S. District Attorney talks Medicare Fraud

GRAND RAPIDS — Portage Hospital LLC, now known as UP Health System Portage, was recently fined more than $4.4 million by the federal government for submitting false Medicare claims.

Patrick Miles Jr. is the U.S. Attorney for the Western District of Michigan. Miles told ABC 10 that he sees Medicare fraud cases all too often.

“There are a lot of bad apples, practitioners who are billing for unnecessary services, perhaps even services that aren’t even performed. Law enforcement agencies, investigative agencies and our office and other offices around the country are making health care fraud a priority and we are vigorously prosecuting these cases. At the same time that we seek criminal charges we often are seeking civil remedies and penalties,” said Miles Jr.

Portage Health Home Care & Hospice turned in false Medicare claims for services supposedly rendered by a staff physical therapist between January 2006 and November 2013. Hospital officials reported the violation themselves, which actually saved the hospital even bigger fines and costs.

“We encourage it. We feel that it is critical to protect the integrity of the federal health care program. When people do self disclosures they will often get significantly lower settlement amounts. We obviously appreciate when they make timely and completely accurate self disclosures.”

Medicare fraud is nothing new in the United States. In fact, some states have more fraud cases than others.

“We have certainly seen areas around the country like Florida where you would have a large beneficiary population with the senior citizens there, there are a lot of health care fraud scams going on there. They are worth a lot of money, there can also be a lot of criminal activity to steal that money,” said Miles.