91 Health Care Professionals Charged In Medicare Fraud Schemes

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Ninety-one individuals, including physicians, nurses, and other medical professionals, have been indicted for their alleged participation in Medicare fraud schemes involving approximately $295 million in false billing, U.S. Attorney General Eric Holder and Kathleen Sebelius, secretary, U.S. Department of Health and Human Services, announced yesterday.

Holder and Sebelius were joined in the announcement by Shawn Henry, executive assistant director, Federal Bureau of Investigation; Assistant Attorney General Lanny A. Breuer of the Justice Department’s Criminal Division; and Inspector General Daniel R. Levinson.

The arrests, coordinated by Medicare Strike Force operations, involved the highest amount of false Medicare billings ever uncovered in a single Strike Force takedown.

The arrested parties stand accused of various health care fraud-related crimes. Among these are conspiracy to defraud the Medicare program, health care fraud, violations of anti-kickback statutes, and money laundering. The charges are based on a range of alleged fraud schemes centered on various medical treatments and services, for example, home health care, physical and occupational therapy, mental health services, psychotherapy, and durable medical equipment (DME).

Court documents indicate that the defendants allegedly participated in schemes to submit claims to Medicare for treatments that were medically unnecessary and frequently never provided. In many cases, indictments and complaints hold that patient recruiters, Medicare beneficiaries, and other co-conspirators received cash kickbacks in return for supplying beneficiary information to providers, so that the latter could submit fraudulent billing to Medicare for such services..

Sebelius says the arrests should serve as “a powerful warning to those who would try to defraud taxpayers and Medicare beneficiaries,” and that they underscore ongoing close cooperation between the Medicare program that identified the perpetrators and the law enforcement officials who acted swiftly to “cut them off”. She adds that efforts to avert such criminal activity “don’t end here” because the Affordable Care Act provides new tools to prevent Medicare fraud before it is committed .

In addition to making arrests, agents executed 18 search warrants in connection with ongoing Strike Force investigations.

“The warning should be unambiguously clear by now,” Levinson concludes. “We will continue using the combined law enforcement might of Strike Forces around the country to combat healthcare fraud.”