Attorney General Loretta E. Lynch and Department of Health
and Human Services (HHS) Secretary Sylvia Mathews Burwell announced today a
nationwide sweep led by the Medicare Fraud Strike Force in 17 districts,
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. In addition, the Centers for
Medicare & Medicaid Services (CMS) also suspended a number of providers
using its suspension authority as provided in the Affordable Care Act. This coordinated takedown is the largest in
Strike Force history, both in terms of the number of defendants charged and
loss amount.
Attorney General Lynch and Secretary Burwell were joined in
the announcement by FBI Director James B. Comey, Assistant Attorney General
Leslie R. Caldwell of the Justice Department’s Criminal Division, Inspector
General Daniel R. Levinson of the HHS Office of Inspector General (HHS-OIG) and
Deputy Administrator and Director of CMS Center for Program Integrity Shantanu
Agrawal, M.D.
The defendants are charged with various health care
fraud-related crimes, including conspiracy to commit health care fraud,
violations of the anti-kickback statutes, money laundering and aggravated
identity theft. The charges are 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 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.
“This action represents the largest criminal health care
fraud takedown in the history of the Department of Justice, and it adds to an
already remarkable record of enforcement,” said Attorney General Lynch. “The defendants charged include doctors,
patient recruiters, home health care providers, pharmacy owners, and
others. They billed for equipment that
wasn’t provided, for care that wasn’t needed, and for services that weren’t
rendered. In the days ahead, the
Department of Justice will continue our focus on preventing wrongdoing and
prosecuting those whose criminal activity drives up medical costs and
jeopardizes a system that our citizens trust with their lives. We are prepared – and I am personally determined
– to continue working with our federal, state, and local partners to bring
about the vital progress that all Americans deserve.”
“This Administration is committed to fighting fraud and
protecting taxpayer dollars in Medicare and Medicaid,” said Secretary
Burwell. “This takedown adds to the
hundreds of millions we have saved through fraud prevention since the
Affordable Care Act was passed. With
increased resources that have allowed the Strike Force to expand and new tools,
like enhanced screening and enrollment requirements, tough new rules and
sentences for criminals, and advanced predictive modeling technology, we have
managed to better find and fight fraud as well as stop it before it starts.”
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 then submit fraudulent bills to Medicare for services that were
medically unnecessary or never performed.
Collectively, the doctors, nurses, licensed medical professionals,
health care company owners and others charged are accused of conspiring to
submit a total of approximately $712 million in fraudulent billing.
“The people charged in this case targeted the system each of
us depends on in our most vulnerable moments,” said Director James Comey. “Health care fraud is a crime that hurts all
of us and each dollar taken from programs that help the sick and the suffering
is one dollar too many.”
“Every day, the Criminal Division is more strategic in our
approach to prosecuting Medicare Fraud,” said Assistant Attorney General
Caldwell. “We obtain and analyze billing
data in real-time. We target hot spots –
areas of the country and the types of health care 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.”
“Health care fraud drives up health care costs, wastes
taxpayer money, undermines the Medicare and Medicaid programs, and endangers
program beneficiaries,” said Inspector General Levinson. “Today’s takedown includes perpetrators of
prescription drug fraud, home health care fraud, and personal care services
fraud, three particularly harmful types of fraud plaguing our health care
system. This record-setting takedown
sends a message to would-be perpetrators that health care fraud is a risky way
to line your pockets. Our agents and our
law enforcement partners stand ready to protect these vital programs and ensure
that those who would steal from federal health care programs ultimately pay for
their crimes.”
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. Since their
inception in March 2007, Strike Force operations in nine locations have charged
over 2,300 defendants who collectively have falsely billed the Medicare program
for over $7 billion.
Including today’s enforcement actions, nearly 900
individuals have been charged in national takedown operations, which have involved
more than $2.5 billion in fraudulent billings.
Today’s announcement marks the first time that districts outside of
Strike Force locations participated in a national takedown, and they accounted
for 82 defendants charged in this takedown.
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In Miami, a total of 73 defendants were charged with
offenses relating to their 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, administrators in a mental health center billed close to $64 million
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. Medicare paid approximately half of the
claimed amount.
In Houston and McAllen, Texas, 22 individuals were charged
in cases involving over $38 million in alleged fraud. One of these defendants 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
of which was paid.
In Dallas, seven people were charged in connection with home
health care schemes. In one scheme, 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 company also
significantly exaggerated the length of physician visits, often times billing
for 90 minutes or more for an appointment that lasted only 15 or 20 minutes.
In Los Angeles, eight defendants were charged for their
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 over 1000 expensive power wheelchairs and home
health services that were not medically necessary and often not provided.
In Detroit, 16 defendants face charges 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. Among these are three owners
of a hospice service who allegedly paid kickbacks for referrals made by two
doctors who defrauded Medicare Part D by issuing medically unnecessary
prescriptions.
In Tampa, five individuals were charged with participating
in a variety of schemes, ranging from fraudulent physical therapy billings to a
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. Medicare paid the defendant over $1 million
for these purported services.
In Brooklyn, N.Y., nine individuals were charged in two
separate criminal schemes involving physical and occupational therapy. In one case, three individuals face charges
for their roles in a previously charged $50 million physical therapy
scheme. In the second case, six
defendants were charged for their roles in a $8 million physical and
occupational therapy scheme.
In New Orleans, 11 people were charged in connection with
$110 million in 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) across the country allegedly sent TGMs to
Medicare beneficiaries regardless of whether they were needed or
requested. The companies billed Medicare
approximately $38 million for the devices and Medicare paid the companies over
$22 million.
The cases announced today are being prosecuted and
investigated by Medicare Fraud Strike Force teams from the Fraud Section of the
Justice Department’s Criminal Division and from the U.S. Attorney’s Offices of
the Southern District of Florida, Eastern District of Michigan, Eastern
District of New York, Southern District of Texas, Central District of
California, Eastern District of Louisiana, Northern District of Texas, Northern
District of Illinois and the Middle District of Florida; and agents from the
FBI, HHS-OIG and state Medicaid Fraud Control Units.
In addition to the Strike Force, today’s enforcement actions
include cases brought by the U.S. Attorney’s Offices of the Southern District
of California, Southern District of Illinois, Northern District of Ohio,
Western District of Kentucky, District of Maryland, District of Connecticut,
District of Alaska and the Southern District of Georgia.
A complaint or indictment is merely a charge, and defendants
are presumed innocent until proven guilty.
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