In a case involving the most defendants charged and largest alleged loss amount in the history of the federal fraud task force, a nationwide sweep has led to 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.
Department of Health and Human Services (HHS) Secretary Sylvia M. Burwell and Attorney General Loretta E. Lynch announced the charges. In addition, the Centers for Medicare & Medicaid Services also suspended several providers using its suspension authority as provided in the Affordable Care Act.
The defendants are charged with various healthcare fraud-related crimes, including conspiracy to commit healthcare fraud, violations of the anti-kickback statutes, money laundering, and aggravated identity theft. The charges are based on alleged fraud schemes involving medical treatments and services, including home health care, psychotherapy, physical and occupational therapy, durable medical equipment, and pharmacy fraud. More than 44 of the defendants arrested are charged with fraud related to the Medicare prescription drug benefit program known as Part D, which is the fastest-growing component of the Medicare program overall.
According to court documents, the defendants participated in alleged schemes to submit claims to Medicare and Medicaid for treatments that were medically unnecessary and often never provided. In many cases, patient recruiters, Medicare beneficiaries, and other co-conspirators allegedly were paid cash kickbacks in return for supplying beneficiary information to providers, so that the providers could submit fraudulent bills to Medicare for services that were medically unnecessary or never performed.
“Every day, the Criminal Division is more strategic in our approach to prosecuting Medicare fraud,” said Assistant Attorney General Leslie R. Caldwell, JD, of the Justice Department’s Criminal Division. “We obtain and analyze billing data in real time. We target hotspots — areas of the country and the types of healthcare services where the billing data shows the potential for a high volume of fraud — and we are speeding up our investigations. By doing this, we are increasingly able to stop schemes at the developmental stage and to prevent them from spreading to other parts of the country.”
The Medicare Fraud Strike Force operations are part of the Health Care Fraud Prevention & Enforcement Action Team (HEAT), a joint initiative announced in May 2009 between the Department of Justice and HHS to focus their efforts to prevent and deter fraud and enforce current anti-fraud laws around the country. Strike Force operations in nine locations have charged more than 2,300 defendants who collectively have falsely billed the Medicare program for more than $7 billion.