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Medicaid and Medicare scams are estimated to cost taxpayers at least $60 billion per year, yet are seldom publicized. Incidents of fraud are startling. To increase public knowledge related to the significance of Medicaid andMedicare fraud, the agencies have published a "Most Wanted" list ( As example, 2 women in Michigan submitted a /9 million claim for infusion drugs that were never provided to patients. Another person billed Medicare for more than a million dollars related to motorized wheelchairs. Upon examination, patients reported they never got the wheelchairs or could not use them for various reasons. One visually impaired man said that he could not see well enough to operate the wheelchair. A nurse-managed company in California collected more than $17 million in reimbursements for patient care that was supposed to be provided by licensed nurses. The only licensed person in the organization was the nurse who collected the money. A group in Miami opened a string of medical clinics and billed for more than $19 million worth of HIV medications. Patients never received the medicine.


Gerald Roy, Deputy Inspector General for Investigations at the Health and Human Services Department, cautions that healthcare scammers frequently take advantage of ties to ethnic communities. The scammers are inclined to exploit low-income communities, people with language barriers, or those with a lack of knowledge about the Medicare or Medicaid system. By making the general public, including nurses and nursing faculty, more aware of the seriousness of these crimes, the government agencies hope to decrease the incidents of fraud. The money saved, if we can prevent fraudulent schemes, can be effectively used to provide healthcare to those who need the services.


Source: Alonso-Zaldivar R. Health care fraud, not a faceless crime any longer. Washington Post (Health Section). February 5, 2011. Available at Accessed February 15, 2011.


Submitted by: Robin E. Pattillo, PhD, RN, CNL, News Editor at [email protected].