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FBI
Health Care
Fraud Takedown
243 Arrested, Charged with $712 Million in False Medicare Billings
06/18/15
More than 240 individuals—including doctors, nurses, and other licensed
professionals—were arrested this week for their alleged participation
in Medicare fraud schemes involving approximately $712 million in false
billings.
The arrests, which began Tuesday, were part of a coordinated operation
in 17 cities by Medicare Fraud Strike Force teams, which include
personnel from the FBI, the Department of Health and Human Services
(HHS), the Department of Justice (DOJ), and local law enforcement. The
Strike Force’s mission is to combat health care fraud, waste, and abuse.
At a press conference today at DOJ Headquarters in Washington, D.C.,
officials said the arrests constituted the largest-ever health care
fraud takedown in terms of both loss amount and arrests.
“These are extraordinary figures,” said Attorney General Loretta Lynch.
“They billed for equipment that wasn’t provided, for care that wasn’t
needed, and for services that weren’t rendered.”
The charges are based on a variety of alleged fraud schemes involving
medical treatments and services. According to court documents, the
schemes included submitting claims to Medicare for treatments that were
medically unnecessary and often not provided. In many of the cases,
Medicare beneficiaries and other co-conspirators were allegedly paid
cash kickbacks for supplying beneficiary information so providers could
submit fraudulent bills to Medicare. Forty-four of the defendants were
charged in schemes related to Medicare Part D, the prescription drug
benefit program, which is the fastest growing component of Medicare and
a growing target for criminals.
“There is a lot of money there, so there are a lot of criminals,” said
FBI Director James B. Comey. He described how investigations leveraged
technology to collect and analyze data, and rapid response teams to
surge where the data showed the schemes were operating. “In these
cases, we followed the money and found criminals who were attracted to
doctors offices, clinics, hospitals, and nursing homes in search of
what they viewed as an ATM.”
Since their inception in 2007, Strike Force teams in the nine cites
where they operate have charged more than 2,300 defendants who
collectively falsely billed Medicare more than $7 billion. Today’s
announcement marked the first time that districts outside Strike Force
locations have participated in a national takedown; those districts
accounted for 82 of the arrests this week.
Here’s a look at some of the cases:
In Miami, 73 were charged in schemes involving about
$263 million in false billings for pharmacy, home health care, and
mental health services.
In Houston and McAllen, 22 were charged in cases
involving more than $38 million. In one case, the defendant coached
beneficiaries on what to tell doctors to make them appear eligible for
Medicare services and then received payment for those who qualified.
The defendant was paid more than $4 million in fraudulent claims.
In New Orleans, 11 people were charged in connection
with home health care and psychotherapy schemes. In one case, four
defendants from two companies sent talking glucose monitors across the
country to Medicare beneficiaries regardless of whether they were
needed or requested. The companies billed Medicare $38 million and were
paid $22 million.
“We will not stop here,” said HHS Secretary Sylvia Mathews Burwell. “We
will work tirelessly to prevent these programs from becoming targets
and fight fraud wherever we find it.”
More than 900 law enforcement officials participated in the three-day
sweep. Those arrested include 46 licensed medical professionals,
including 19 doctors. Since 2007, the Medicare Fraud Strike Force has
prosecuted more than 200 doctors and more than 400 medical
professionals.
In fiscal year 2014, DOJ and HHS health care fraud and prevention
efforts recovered nearly $3.3 billion. Over the past five years, DOJ
specifically has recovered more than $15 billion in cases involving
health care fraud. The average prison sentence in Strike Force cases in
fiscal year 2014 was more than four years, though some prosecutions in
recent years resulted have in sentences of 50 years.
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