The recent arrest of 301 people for healthcare fraud brings the campaign against fraudulent billing to another level and illustrates that licensed professionals are as vulnerable as everyone else.
Attorney General Loretta E. Lynch and Sylvia Mathews Burwell, secretary of the Department of Health and Human Services (HHS), recently announced an unprecedented nationwide sweep led by the Medicare Fraud Strike Force in 36 federal districts. The sweep resulted in criminal and civil charges against 301 individuals, including 61 doctors, nurses, and other licensed medical professionals, for their alleged participation in healthcare fraud schemes involving about $900 million in false billings.
In addition, CMS is suspending payment to several providers using its suspension authority provided in the Affordable Care Act. This coordinated takedown is the largest in history in terms of the number of defendants charged and loss amount, HHS says.
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 healthcare, psychotherapy, physical and occupational therapy, durable medical equipment, and prescription drugs.
A significant difference from previous fraud investigations is that more than 60 of the defendants arrested are charged with fraud related to the Medicare prescription drug benefit program known as Part D, says Mark Hardiman, JD, a partner with healthcare law firm Nelson Hardiman in Los Angeles. He specializes in representing and advising healthcare providers with respect to criminal investigations and charges, civil False Claims Act allegations, and fraud lawsuits. Part D is the fastest-growing component of the Medicare program overall.
These arrests should alert the healthcare community that no one is immune from prosecution, Hardiman says.
“While DOJ [the Department of Justice] has announced a grab-bag of healthcare fraud cases across the country, the charging of more than 60 physicians and other licensed healthcare professionals is noteworthy,” Hardiman says. “Historically, licensed professionals have been more difficult to prosecute for healthcare fraud because they have significant leeway in practicing medicine and also have the resources to aggressively defend themselves. Clearly, DOJ is sending a message that healthcare professionals who engage in fraud will be aggressively prosecuted.”
Court documents allege that the defendants participated in 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. Collectively, the doctors, nurses, licensed medical professionals, healthcare company owners, and others charged are accused of submitting about $900 million in fraudulent billing.
The Medicare Fraud Strike Force has charged more than 2,900 defendants who collectively have falsely billed the Medicare program for more than $8.9 billion.
- Mark Hardiman, JD, Partner, Nelson Hardiman, Los Angeles. Telephone: (310) 203-2800. Email: firstname.lastname@example.org.