A Justice Department strike force on Thursday charged 111 persons in nine cities — including doctors, nurses, health care company owners and executives — in suspected Medicare fraud schemes involving more than $225 million in false billings.
It was the largest-ever federal health care fraud takedown.
Attorney General Eric H. Holder Jr., said that more than 700 law enforcement agents from the FBI, the Inspector General’s Office at the Department of Health and Human Services (HHS), multiple Medicaid Fraud Control Units, and other state and local law enforcement agencies participated in the operation — executing search warrants across the country in connection with ongoing strike-force investigations.
Mr. Holder said arrests were made in Miami, Detroit, New York, Houston, Dallas, Los Angeles and Chicago, as well as Baton Rouge, La., and Tampa, Fla.
“With this takedown, we have identified and shut down large-scale fraud schemes operating throughout the country,” Mr. Holder said. “We have safeguarded precious taxpayer dollars. And we have helped to protect our nation’s most essential health care programs, Medicare and Medicaid.
“As today’s arrests prove, we are waging an aggressive fight against health care fraud,” he said.
The arrests were part of an ongoing operation by the Medicare Fraud Strike Force, a joint Justice Department and Health and Human Services team of federal, state and local investigators designed to combat Medicare fraud through the use of Medicare data-analysis techniques and an increased focus on community policing.
HHS Secretary Kathleen Sebelius said strike-force efforts have more than quadrupled over the past two years, bringing hundreds of charges against criminals who had billed Medicare for hundreds of millions of dollars. She said the strike force recovered $4 billion last year on behalf of taxpayers.
“Every dollar the federal government spent under its health care fraud and abuse-control programs averaged a return on investment of $6.80.”
The charges include a variety of health care fraud-related crimes: Conspiracy to defraud the Medicare program, criminal false claims, violations of the anti-kickback statutes, money laundering and aggravated identity theft. The listed fraud schemes involve various medical treatments and services such as home health care, physical and occupational therapy, nerve-conduction tests and durable medical equipment.
According to court documents, the charges included submitting claims to Medicare for treatments that were medically unnecessary and oftentimes never provided. In many cases, the indictments and complaints allege patient recruiters, Medicare beneficiaries and other co-conspirators were paid cash kickbacks in return for information to providers to use to submit fraudulent billing to Medicare for services that were medically unnecessary or never provided.
Those arrested included 32 in Miami, along with two doctors and eight nurses, charged in various fraud schemes involving $55 million in false billings for home health care, durable medical equipment and prescription drugs. Twenty-one persons, including three doctors, three physical therapists and one occupational therapist, were charged in Detroit in schemes to defraud Medicare of more than $23 million.
In New York, 10 persons, including three doctors and one physical therapist, were charged with fraud schemes involving $90 million in false billings for physical therapy, proctology services and nerve-conduction tests. Ten persons were charged in Tampa involving more than $5 million related to false claims for physical therapy, durable medical equipment and pharmaceuticals.
Nine persons were charged in Houston involving $8 million in fraudulent Medicare claims for physical therapy, durable medical equipment, home health care and chiropractor services. In Dallas, seven persons were indicted for conspiring to submit $2.8 million in false billing to Medicare related to durable medical equipment and home health care.
Five persons were charged in Los Angeles in schemes to defraud Medicare of more than $28 million. In Baton Rouge, six persons were charged for a durable medical equipment fraud scheme involving more than $9 million in false claims, and in Chicago, 11 persons were charged with improperly billing Medicare more than $6 million for home health, diagnostic testing and prescription drugs.