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NASW Responds to Reports of $452M Medicare Fraud Busts

The Associated Press and other news outlets today reported federal authorities have charged 107 people in seven cities with filing fraudulent Medicare claims totaling $452 million.

This is the highest dollar amount ever recorded in any single Medicare bust, according to this AP article.

Doctors, nurses and at least one social worker have been arrested.

Some of the facilities involved in the busts provided mental healthcare, healthcare and other services to some of the nation’s most vulnerable populations in Miami, Los Angeles, Houston, Detroit, Chicago, Tampa, Fla., and Baton Rouge, La.

The National Association of Social Workers issued this statement in response to the charges:

NASW Applauds Obama Administration Efforts to

Eliminate Medicare and Medicaid Fraud

 Washington, D.C. (May 3, 2012) The National Association of Social Workers vigorously supports the U.S. Department of Health and Human Services and the Justice Department in their efforts to eliminate Medicare and Medicaid fraud.  News reports of arrests made on Wednesday of more than 100 people in seven cities for $450 million in alleged fraudulent billing is disturbing on many levels. The Association is concerned that any social worker may be involved in these cases.  To date, one clinical social worker has been named.

The social work profession’s Code of Ethics is clear that professional social workers “should not participate in, condone, or be associated with dishonesty, fraud, or deception.” In addition, the Code prohibits social workers from taking unfair advantage of any professional relationship or exploiting others to further their personal or business interests. NASW imposes professional sanctions on social workers who engage in criminal behavior. If a social worker is found guilty of a felony their NASW membership is summarily revoked. NASW also terminates membership of social workers whose licenses have been revoked by a state social work licensing board.

Social workers are critical providers of mental health and psychotherapy services in every community. They assist millions of people by developing and implementing multi-level interventions that serve individuals, families, and communities. The illegal behavior of any professional who claims to serve people in need, but then uses those resources for personal gain, is unacceptable.

Among social workers, only those licensed at the clinical level may be approved for Medicare reimbursement of psychotherapy services.  According to recently updated figures from the Bureau of Labor Statistics, there are more than 650,000 professionally trained social workers in the United States, including 200,000 licensed clinical social workers.  Social workers who operate or administer a practice that serves Medicaid and Medicare clients need to be fully versed in the rules for these public programs and aware of their obligations to clients as well as to the public trust.

NASW is proud that social workers in recent years have acted as whistleblowers and assisted in exposing the fraudulent schemes of employers.  NASW is confident that the current administration’s heightened enforcement efforts will help ensure that vulnerable citizens, including the elderly, HIV patients and persons with mental illness or disabilities, receive appropriate care provided by these essential government programs.

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