301 people charged in massive $900 million false billings Medicare fraud
More than 60 of the defendants arrested are charged with fraud related to the Medicare prescription drug benefit program known as Part D.
A nationwide sweep led by the Medicare Fraud Strike Force in 36 federal districts resulted in criminal and civil charges Wednesday 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. Twenty-three state Medicaid Fraud Control Units also participated in the arrests.
Additionally, the Centers for Medicare and Medicaid Services is suspending payment to a number of providers using the suspension authority provided in the Affordable Care Act. According to the Department of Justice, this coordinated takedown is the largest in history, both in terms of the number of defendants charged and the amount lost.
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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 a variety of alleged fraud schemes involving various medical treatments and services, including home health care, psychotherapy, physical and occupational therapy, durable medical equipment and prescription drugs.
More than 60 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 allegedly 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 were allegedly paid cash kickbacks in return for supplying beneficiary information to providers, so that the providers could then submit fraudulent bills to Medicare for unnecessary or never-performed services.
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Collectively, the doctors, nurses, licensed medical professionals, healthcare company owners and others charged are accused of submitting a total of approximately $900 million in fraudulent billing.
The Medicare Fraud Strike Force operations are part of the Health Care Fraud Prevention and Enforcement Action Team, a joint initiative announced in May 2009 between the Department of Justice and HHS to focus their efforts on preventing and deterring fraud, and enforcing current anti-fraud laws around the country. The Medicare Fraud Strike Force operates in nine locations, and since its inception in March 2007 has charged over 2,900 defendants who collectively have falsely billed the Medicare program for over $8.9 billion.
Including today's charges, nearly 1,200 individuals have been charged in national takedown operations, which have involved more than $3.4 billion in fraudulent billings. Wednesday marks the second time that districts outside of Strike Force locations participated in a national takedown, and they accounted for 82 of the defendants charged.
"Our action shows that this administration remains committed to cracking down on individuals who try to defraud the program," said HHS Secretary Sylvia Burwell in a statement. "We are continuing to put new tools and additional resources to work, including $350 million from the Affordable Care Act, for health care fraud prevention and enforcement efforts."
Attorney General Loretta Lynch said in a statement that healthcare fraud "is not an abstract violation or benign offense. It is a serious crime."
Twitter: @JELagasse
