On June 18, 2015, the U.S. Attorney General and the Department of Health and Human Services (HHS) announced the largest nationwide sweep led by the Medicare Fraud Strike Force, resulting in charges against 243 individuals, including 46 doctors, nurses, and other licensed medical professionals, for their alleged participation in Medicare fraud schemes involving approximately $712 million in false billings. The Centers for Medicare & Medicaid Services (CMS) also suspended a number of providers under the Affordable Care Act.
The sweep was the largest in the history of the Medicare Fraud Strike Force, which is part of the Health Care Fraud Prevention & Enforcement Action Team (HEAT) that focuses on efforts to prevent and deter fraud and enforce current anti-fraud laws throughout the United States. Since March 2007, the Strike Force’s efforts in nine locations have resulted in charges against over 2,300 defendants who collectively have falsely billed the Medicare program for over $7 billion. This most recent sweep was the largest in terms of the number of defendants charged and the amount of the losses.
The defendants, which include doctors, patient recruiters, home health care providers, pharmacy owners, and others, have been charged with health care fraud-related crimes, including conspiracy to commit health care fraud, violations of the anti-kickback statutes, money laundering, and aggravated identity theft, based on a variety of alleged fraud schemes involving various medical treatments and services, including home health care, psychotherapy, physical and occupational therapy, durable medical equipment (DME), and pharmacy fraud.
More than 44 of the defendants are charged with fraud related to the Medicare prescription drug benefit program under Part D, which is the fastest-growing component of the Medicare program.
The government alleges that the defendants participated in schemes to submit claims to Medicare and Medicaid for treatments that were medically unnecessary and often never provided. The government further alleges that in many cases, 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 then submit fraudulent bills to Medicare for services that were medically unnecessary or never performed, conspiring to submit a total of approximately $712 million in fraudulent billing.
The Miami Sweep
Seventy-three defendants in Miami, Florida were charged with offenses relating to their alleged participation in various fraud schemes involving approximately $263 million in false billings for home health care, mental health services, and pharmacy fraud. In one case, the administrators in a mental health center billed close to $64 million (of which Medicare paid approximately one-half) between 2006 and 2012 for purported intensive mental health treatment to beneficiaries and allegedly paid kickbacks to patient recruiters and assisted living facility owners throughout the Southern District of Florida.
The Texas Sweep
Twenty-two defendants in Houston and McAllen, Texas were charged in cases involving over $38 million in alleged fraud. In one case, the defendant allegedly coached beneficiaries on what to tell doctors to make them appear eligible for Medicare services and treatments and then received payment for those who qualified (the company that paid the defendant for patients submitted close to $16 million in claims to Medicare – over $4 million was paid by Medicare).
Seven defendants in Dallas, Texas were charged in connection with alleged home health care schemes. In one case, six owners and operators of a physician house call company submitted nearly $43 million in billings under the name of a single doctor, regardless of who actually provided the service. The same company also allegedly exaggerated the length of physician visits, often billing for 90 minutes or more for an appointment that lasted only 15 to 20 minutes.
The Los Angeles Sweep
Eight defendants in Los Angeles, California were charged for their alleged roles in schemes to defraud Medicare of approximately $66 million. In one case, a doctor is charged with causing almost $23 million in losses to Medicare through his own fraudulent billing and referrals for DME, including billings for over 1,000 expensive power wheelchairs and home health services that were not medically necessary and often not provided.
The Detroit Sweep
Sixteen defendants in Detroit, Michigan were charged for their alleged roles in fraud, kickback, and money laundering schemes involving approximately $122 million in false claims for services that were medically unnecessary or never rendered, including home health care, physician visits, and psychotherapy, as well as pharmaceuticals that were billed but not dispensed. In one case, three owners of a hospice service allegedly paid kickbacks for referrals made by two doctors who defrauded Medicare Part D by issuing medically unnecessary prescriptions.
The Tampa Sweep
Five defendants in Tampa, Florida were charged with participating in a variety of alleged schemes, ranging from fraudulent physical therapy billings to an alleged scheme involving millions in physician services and tests that never occurred. In one case, a licensed pain management physician sought reimbursement for nerve conduction studies and other services that he allegedly never performed for which the defendant was paid over $1 million by Medicare.
The Brooklyn Sweep
Nine defendants in Brooklyn, New York were charged in two separate alleged criminal schemes involving physical and occupational therapy. In one case, three defendants were charged for their alleged roles in a previously charged $50 million physical therapy scheme. In the other case, six defendants were charged for their alleged roles in a $8 million physical and occupational therapy scheme.
The New Orleans Sweep
Eleven defendants in New Orleans, Louisiana were charged in connection with $110 million in alleged home health care and psychotherapy schemes. In one case, four individuals who operated two companies (one in Louisiana and one in California) that mass-marketed talking glucose monitors (TGMs) throughout the United States allegedly sent TGMs to Medicare beneficiaries regardless of whether they were needed or requested, for which the companies billed Medicare approximately $38 million for the devices (Medicare paid the companies over $22 million).
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