U.S. Probes Alleged $2-B Medicare Fraud Scheme

The complaints that ensnared Pretty in Pink Boutique, a Tennessee cancer-care business, for “charging” health insurance firms thousands of dollars for urinary catheters are just one piece of an alleged fraud scheme whose scale has little precedent in the history of Medicare, experts said—an estimated $2 billion—Dan Diamond, Lauren Weber, and Dan Keating reported for Washington Post.

The alleged scheme was uncovered by the National Association of ACOs - known as NAACOS - a healthcare nonprofit that represents hundreds of medical groups and hospitals across the nation. I Photo: Pretty in Boutique Facebook

The months-long episode involves fraudulent insurance claims submitted by seven companies to the taxpayer-funded health insurance program for older Americans, said healthcare groups that have analyzed Medicare billing data.

Federal officials investigating the fraudulent billing for catheters are looking into several of the companies that may be involved, said three officials who spoke on the condition of anonymity to discuss the probe and three people who said the FBI approached them.

The investigation’s existence has not been previously reported.

The alleged scheme was uncovered by the National Association of ACOs - known as NAACOS - a healthcare nonprofit that represents hundreds of medical groups and hospitals across the nation.

The nonprofit’s members concluded that seven companies operating out of Connecticut, Florida, Kentucky, New York, and Texas were behind a surge of bills submitted to Medicare in the last two years for intermittent urinary catheters - tubes that patients insert several times a day to drain their bladders and treat incontinence.

While the companies used real patients’ information to submit the bills, NAACOS and its members found no evidence that any of their patients wanted the catheters or even received them.

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