The U.S. Department of Justice announced on October 4, 2012 that 91 nurses, physicians, and other medical providers in seven U.S. cities (listed below) have been criminally charged for alleged false billings to Medicare that totaled $429.2 million (more than $230 million in home health care fraud; more than $100 million in mental health care fraud; more than $49 million in ambulance transportation fraud; and, millions more in other cases of fraud).
The criminal charges involved services that included home health care, mental health services, psychotherapy, physical and occupational therapy, durable medical equipment (DME), and ambulance services. The alleged illegal actions included conspiracy to commit health care fraud, health care fraud, violations of the anti-kickback statutes, and money laundering.
Many of the fraudulent schemes alleged by the U.S. government involved billing Medicare for services and treatments never provided and/or for medical treatments that were not medically necessary. Kickbacks paid in cash were allegedly paid to Medicare beneficiaries and “patient recruiters” for the use of beneficiaries’ Medicare information so that fraudulent bills could be submitted to Medicare for payment.
Miami Medical Providers Billed For Unnecessary/Unprovided Medical Services
Thirty-three individuals in Miami, Florida were charged in fraudulent schemes that involved $204.5 million in false billings for home health care, mental health services, occupational and physical therapy, and DME. Three of the criminal defendants were allegedly involved with one particular company that falsely billed Medicare $74 million. Five others were allegedly involved with another company that fraudulently billed Medicare approximately $67 million for mental health services.
Los Angeles Not Far Behind
Sixteen individuals in Los Angeles, California (including three doctors and one licensed physical therapist) were charged in Medicare false billiing schemes that totalled $53.8 million. One ambulance company supposedly was involved in fraudulently billing Medicare for unnecessary ambulance transportation services in the approximate amount of $49.2 million.
Dallas Fraudulent Billings Involved Hundreds Of Millions
Fourteen individuals in Dallas, Texas, including two doctors and two registered nurses, were charged with alleged false billing schemes that totalled $103.3 million. In another Dallas case, a doctor and two registered nurses were charged with participating in a fraud scheme involving home health care services that totalled approximately $100 million in fraudulent billings (the doctor was charged with signing about 33,000 prescriptions for home health services for more than 2,000 Medicare beneficiaries over a six-year period).
Houston, We’ve Got A Problem
Seven individuals in Houston, Texas were charged in a fraud scheme involving a hospital and community mental health center services that allegedly resulted in fraudulent billings in the amount of $158 million. The fraud allegedly involved the payment of kickbacks (cigarettes, food, and coupons redeemable for items available at the hospital’s “country stores”) to Medicare beneficiaries. One of the hospital’s administrators had previously pleaded guilty in a scheme that paid kickbacks related to $116 million in fraudulent claims submitted to Medicare (after the administrator’s guilty plea, an additional $42 million in fraudulent claims were uncovered).
Brooklyn Shares In The Shame
Fifteen individuals in Brooklyn, New York, including one doctor and four chiropractors, were charged with participation in a fraud scheme that resulted in $23.2 million in false billings. Nine individuals were allegedly involved in fraud schemes involving kickbacks related to unnecessary or never-provided physical therapy services that resulted in $13.8 million in false billings.
The Heat Is On In Baton Rouge
Four individuals in Baton Rouge, Louisiana were charged in an alleged fraud scheme involving durable medical equipment that resulted in about $2.4 million in false billings.
Chicago, Last But Not Least
Two individuals in Chicago, Illinois (a dermatologist and a psychologist) were charged in a fraud scheme involving millions of dollars in false billings for medically unnecessary laser treatments and psychotherapy services.
Can you understand why we are incensed when doctors complain voraciously about “frivolous medical malpractice lawsuits” yet they remain deafeningly silent about their colleagues who cheat and steal from the Medicare program?
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