Expanding Medicare Fraud Strike Force Grabs 111 for
$225 Million in False Billing
Doctors, nurses, health care company owners and
executives among the defendants charged
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Feb. 18, 2011 - The Medicare Fraud Strike Force
yesterday charged 111 defendants in nine cities, including doctors,
nurses, health care company owners and executives, and others, for their
alleged participation in Medicare fraud schemes involving more than $225
million in false billing.
The announcement was made by Attorney General Eric
Holder, Health and Human Services (HHS) Secretary Kathleen Sebelius, FBI
Executive Assistant Director Shawn Henry, Assistant Attorney General
Lanny A. Breuer of the Criminal Division and HHS Inspector General
Daniel Levinson.
Also today, the Department of Justice (DOJ) and HHS
announced the expansion of Medicare Fraud Strike Force operations to two
additional cities – Dallas and Chicago. Today’s operation is the
largest-ever federal health care fraud takedown.
The joint DOJ-HHS Medicare Fraud Strike Force is a
multi-agency 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.
More than 700
law enforcement agents from the FBI, HHS-Office of Inspector General (HHS-OIG),
multiple Medicaid Fraud Control Units, and other state and local law
enforcement agencies participated in today’s operation. In addition to
making arrests, agents also executed 16 search warrants across the
country in connection with ongoing strike force investigations.
“With this takedown, we have identified and shut
down large-scale fraud schemes operating throughout the country. We
have safeguarded precious taxpayer dollars. And we have helped to
protect our nation’s most essential health care programs, Medicare and
Medicaid,” said Attorney General Holder.
“As today’s arrest prove, we are waging an
aggressive fight against health care fraud.”
HHS Secretary Sebelius added, “Over the last two
years our joint efforts have more than quadrupled the number of
anti-fraud Strike Force teams operating in fraud hot spots around the
country from two to nine -- with the latest additions Chicago and Dallas
-- bringing hundreds of charges against criminals who had billed
Medicare for hundreds of millions of dollars.
“Last year alone, our partnership recovered a
record $4 billion on behalf of taxpayers. From 2008-2010, every dollar
the Federal Government spent under its Health Care Fraud and Abuse
Control programs averaged a return on investment of $6.80.”
The defendants charged today are accused of various
health care fraud-related crimes, including conspiracy to defraud the
Medicare program, criminal false claims, 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 such as home health care, physical and
occupational therapy, nerve conduction tests and durable medical
equipment.
According to court documents, the defendants
charged today participated in schemes to submit claims to Medicare for
treatments that were medically unnecessary and oftentimes, never
provided. In many cases, indictments and complaints allege that patient
recruiters, Medicare beneficiaries and other co-conspirators were paid
cash kickbacks in return for supplying beneficiary information to
providers, so that the providers could submit fraudulent billing to
Medicare for services that were medically unnecessary or never provided.
Collectively, the doctors, nurses, health care
company owners, executives and others charged in the indictments and
complaints are accused of conspiring to submit a total of more than $225
million in fraudulent billing.
“Every American bears the burden of health care
fraud, and the FBI, in conjunction with our inter-agency partners, will
continue to dismantle criminal networks that bilk the system,” said
Shawn Henry, Executive Assistant Director of the FBI’s Criminal, Cyber,
Response and Services Branch. “Our agents and analysts use task forces
and undercover operations to identify individuals who treat the health
care system as a vehicle to line their pockets.”
“Today, Strike Force operations have charged
doctors, nurses, health care executives, and others – from Los Angeles
to New York and cities in between – with engaging in Medicare fraud
schemes that cheat taxpayers and patients alike,” said Assistant
Attorney General Breuer. “With this nationwide takedown and the
expansion of the Strike Force to two additional cities, our message is
clear: we are determined to put Medicare fraudsters out of business.”
“Today, more than 300 special agents from OIG, in
partnership with federal and state agencies across the country, are
making more than a hundred arrests on charges of health care
fraud,” said Daniel R. Levinson, HHS Inspector General. “These
unprecedented operations send a clear message – we will not tolerate
criminals lining their pockets at the expense of Medicare patients and
taxpayers.”
In Miami, 32 defendants, including 2 doctors and 8
nurses, were charged for their participation in various fraud schemes
involving a total of $55 million in false billings for home health care,
durable medical equipment and prescription drugs. Twenty-one
defendants, including three doctors, three physical therapists and one
occupational therapist, were charged in Detroit for schemes to defraud
Medicare of more than $23 million. The Detroit cases involve false
claims for home health care, nerve conduction tests, psychotherapy,
physical therapy and podiatry.
In Brooklyn, N.Y., 10 individuals, 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 defendants were charged in
Tampa for participating in schemes involving more than $5 million
related to false claims for physical therapy, durable medical equipment
and pharmaceuticals.
Nine individuals were charged in Houston for
schemes involving $8 million in fraudulent Medicare claims for physical
therapy, durable medical equipment, home health care and chiropractor
services. In Dallas, seven defendants were indicted for conspiring to
submit $2.8 million in false billing to Medicare related to durable
medical equipment and home health care.
Five defendants were charged in Los Angeles for
their roles in schemes to defraud Medicare of more than $28 million.
The cases in Los Angeles involve false claims for durable medical
equipment and home health care. In Baton Rouge, La., six individuals
were charged for a durable medical equipment fraud scheme involving more
than $9 million in false claims.
In Chicago, charges were filed against 11
individuals associated with businesses that have billed Medicare more
than $6 million for home health, diagnostic testing and prescription
drugs.
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 districts have charged more than 990 individuals who
collectively have falsely billed the Medicare program for more than $2.3
billion. In addition, the HHS Centers for Medicare and Medicaid
Services, working in conjunction with the HHS-OIG, are taking steps to
increase accountability and decrease the presence of fraudulent
providers.
The cases announced today are being prosecuted and
investigated by Strike Force teams comprised of attorneys from the Fraud
Section in the Justice Department’s Criminal Division and from the U.S.
Attorney’s Offices for the Southern District of Florida, the Eastern
District of Michigan, the Eastern District of New York, the Middle
District of Florida, the Southern District of Texas, the Central
District of California, the Middle District of Louisiana; the Northern
District of Illinois, and the Northern District of Texas; and agents
from the FBI, HHS-OIG, and state Medicaid Fraud Control Units.
An indictment is merely a charge and defendants are
presumed innocent until proven guilty.
To learn more about the Health Care Fraud
Prevention and Enforcement Action Team (HEAT), go to:
www.stopmedicarefraud.gov.
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