Medicare Strike Force Nabs 91 People in $430 Million Fraud

Native News Network Staff in Native Health. Discussion »

WASHINGTON – Medicare Fraud Strike Force operations in seven cities have led to charges against 91 individuals - including doctors, nurses and other licensed medical professionals - for their alleged participation in Medicare fraud schemes involving approximately $429.2 million in false billing, Attorney General Eric Holder and Health and Human Services, HHS, Secretary Kathleen Sebelius announced.

Human Services Secretary Kathleen Sebelius and
Attorney General Eric Holder Press Briefing

Attorney General Holder and Secretary Sebelius were joined in the announcement of the nationwide takedown by Assistant Attorney General Lanny A. Breuer of the Justice Department's Criminal Division, FBI Associate Deputy Director Kevin Perkins, Inspector General Daniel R. Levinson of the HHS Office of Inspector General (HHS-OIG) and Dr. Peter Budetti, Deputy Administrator for Program Integrity of the Centers for Medicare and Medicaid Services (CMS).

"Today's enforcement actions reveal an alarming and unacceptable trend of individuals attempting to exploit federal health care programs to steal billions in taxpayer dollars for personal gain,<"

said Attorney General Holder.

"Such activities not only siphon precious taxpayer resources, drive up health care costs, and jeopardize the strength of the Medicare program, they also disproportionately victimize the most vulnerable members of society, including elderly, disabled and impoverished Americans."

"Today's arrests put criminals on notice that we are cracking down hard on people who want to steal from Medicare,"

said Health & Human Services Secretary Sebelius.

"The health care law gives us new tools to better fight fraud and make Medicare stronger. In addition to the arrests made today, Health & Human Services used new authority from the health care law to stop future payments to many of the health care providers suspected of fraud, saving Medicare resources and taxpayer dollars from being lost to fraud in the first place."

Dozens of charged individuals were arrested or surrendered in the last 24 hours as indictments were unsealed across the country. Together, those indictments charge more than $230 million in home health care fraud; more than $100 million in mental health care fraud and more than $49 million in ambulance transportation fraud; and millions more in other frauds.

HHS also suspended or took other administrative action against 30 health care providers following a data-driven analysis and based upon credible allegations of fraud. Under the Affordable Care Act, Health & Human Services is able to suspend payments until the resolution of an investigation.

The joint Department of Justice and HHS Medicare Fraud Strike Force is a multi-agency team of federal, state and local investigators and prosecutors designed to combat Medicare fraud through the use of Medicare data analysis techniques. More than 500 law enforcement agents from the FBI, HHS-OIG, multiple Medicaid Fraud Control Units, and other state and local law enforcement agencies participated in the takedown.

The defendants charged are accused of various health care fraud-related crimes, including conspiracy to commit health care fraud, health care fraud, violations of the anti-kickback statutes and money laundering. The charges are based on a variety of alleged fraud schemes involving various medical treatments and services such as home health care, mental health services, psychotherapy, physical and occupational therapy, durable medical equipment (DME) and ambulance services.

According to court documents, the defendants allegedly participated in schemes to submit claims to Medicare for treatments that were medically unnecessary and often times never provided. In many cases, court documents allege that patient recruiters, Medicare beneficiaries and other co-conspirators were paid cash kickbacks in return for supplying beneficiary information to providers, so that the providers could submit fraudulent billing to Medicare for services that were medically unnecessary or never provided. Collectively, the doctors, nurses, licensed medical professionals, health care company owners and others charged are accused of conspiring to submit a total of approximately $429.2 million in fraudulent billing.

"Health care fraud leads to higher health care costs and makes quality care more difficult to obtain,"

said FBI Associate Deputy Director Perkins.

"Working together to stop fraud, as we did today, will ensure that Americans' hard earned dollars are used to care for the sick - not to line the pockets of criminals."

"Today's coordinated operation demonstrates that law enforcement is flexible enough to address health care fraud in its many evolving forms,"

said HHS Inspector General Levinson.

"When home health agencies, durable medical equipment companies, pharmacies, or other health care providers are suspected of breaking the law, they can expect to be caught and held accountable."

"This is the result of coordinated anti-fraud efforts - including Medicare flagging suspicious activity, efforts between agencies to investigate this criminal activity, and today's actions by law enforcement and HHS,"

said CMS Deputy Administrator for Program Integrity Budetti.

"As we stop payments to these providers suspected of fraud, we continue our efforts to move from a pay and chase model to one where we stop fraudsters before they can successfully bill Medicare and Medicaid."

In Miami, a total of 33 defendants are charged for their alleged participation in various fraud schemes involving a total of $204.5 million in false billings for home health care, mental health services, occupational and physical therapy, and DME. In one case, three defendants are charged for participating in a fraud scheme at LTC Professional Consultants and Professional Home Care Solutions Inc. which led to approximately $74 million in fraudulent billing for home health care. In another case, five defendants are charged for participating in a fraud scheme at Hollywood Pavilion which led to $67 million in fraudulent billing for mental health services.

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posted October 5, 2012 7:20 am edt