Historic multi-jurisdiction health care fraud investigation results in over 300 arrests related to $900 million in fraudulent billing
On June 22, 2016, the Medicare Fraud Strike Force made over 300 arrests in 36 federal districts on various civil and criminal charges of health care fraud — a record number. The Medicare Fraud Strike Force, which was founded in 2007, is made up of federal, state and local enforcement groups and relies on data analysis and community policing to combat health care fraud. Strike Force efforts are also part of the Health Care Fraud Prevention and Enforcement Action Team (HEAT), a joint initiative involving the Department of Justice and Health and Human Services (HHS), to deter fraud and investigate and enforce anti-fraud laws.
The defendants include doctors, nurses and other licensed medical professionals. Among the charges are conspiracy to commit healthcare fraud, violations of the federal anti-kickback statutes, money laundering and aggravated identify theft, among others.
The defendants allegedly participated in schemes to submit claims to Medicare and Medicaid for treatments that were medically unnecessary and, in some cases, never provided. These schemes involved medical treatment and services, including home health care, psychotherapy, physical and occupational therapy, durable medical equipment (DME) and prescription drugs. More than 60 of the defendants were arrested on charges of fraud relating to Medicare Part D, the federal prescription drug benefit program.
In some cases, authorities allege that patient recruiters, Medicare beneficiaries and other co-conspirators were paid cash kickbacks for supplying beneficiary information that providers could use to submit fraudulent bills to Medicare.
Cases are currently pending in the following districts:
- 100 defendants were charged in the Southern District of Florida involving approximately $220 million in false billings for home health care, mental health services and pharmacy fraud.
- 24 defendants were charged in the Southern District of Texas involving over $146 million in fraudulent home health referrals and medically unnecessary home health services that were not always provided.
- 11 defendants were charged in the Northern District of Texas involving over $47 million in alleged fraud for allowing unlicensed individuals to perform physician services and certifying patients for home health care that was medically unnecessary.
- 22 defendants were charged in the Central District of California involving approximately $162 million in fraudulent billing and performing unnecessary treatments.
- 19 defendants were charged in the Eastern District of Michigan for alleged roles in fraud, kickbacks, money laundering and drug distribution schemes involving approximately $114 million in false claims for services that were medically unnecessary or never provided.
- 15 defendants were charged in pharmacy and prescription drug fraud in Tampa and other areas within the Middle District of Florida involving $17 million in fraudulent billing.
- 6 defendants were charged in the Northern District of Illinois in cases related to schemes involving bribery and false and fraudulent claims for home health services and disability benefits.
- 10 defendants were charged in the Eastern District of New York for a scheme involving over $86 million in kickbacks and medically unnecessary physical and occupational therapy.
- 3 defendants were charged in the Eastern District of Louisiana in connection with payment of kickbacks to patient recruiters for patients that never received or qualified for home health care as billed to Medicare.
In a statement accompanying the announcement, HHS Secretary Sylvia Mathews Burwell stated, "[O]ur action shows that this administration remains committed to cracking down on individuals who try to defraud the program[….]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."
This is for informational purposes only. It is not intended to be legal advice and does not create or imply an attorney-client relationship.Download PDF