Medicare Fraud Schemes Result In 89 Charged With $223 Million In False Billings

162017_132140396847214_292624_nOn May 14, 2013, the U.S. Attorney General and the Secretary of the U.S. Department of Health and Human Services (“HHS”)  announced that 89 people in eight U.S. cities were charged with participating in Medicare fraud schemes that resulted in about $223 million in fraudulent billings. Those charged included included doctors, nurses, and other licensed medical professionals. The nationwide take-down was undertaken by the Medicare Fraud Strike Force, which is part of the Health Care Fraud Prevention & Enforcement Action Team (HEAT). HEAT is a joint initiative between the Department of Justice (“DOJ”) and HHS to focus efforts to prevent and deter fraud and enforce current anti-fraud laws in the United States.

Those who were charged are accused of fraud-related crimes such as conspiracy to commit health care fraud, violations of the anti-kickback statutes, and money laundering.  The fraudulent schemes involve primarily home health care but also involve mental health services, psychotherapy, physical and occupational therapy, durable medical equipment (“DME”), and ambulance services.

The alleged fraud involved schemes to submit claims to Medicare for treatments that were medically unnecessary and often never provided. The allegations claim that so-called patient recruiters, Medicare beneficiaries, and other co-conspirators were paid cash as illegal kick-backs for supplying Medicare beneficiary information to providers so that they could submit fraudulent billing to Medicare for services that were medically unnecessary or never performed.

1. The Miami Allegations

Twenty-five defendants (including two nurses, a paramedic, and a radiographer) were charged with participation in various fraud schemes involving a total of $44 million in false billings for home health care, mental health services, occupational and physical therapy, DME, and HIV infusion. Three of the defendants were charged for their alleged participation in a $20 million home health fraud scheme involving a home health agency that allegedly bribed Medicare beneficiaries for their Medicare information that was then used to bill for home health services that were not rendered or were not medically necessary.

2. The New Orleans Allegations

Eleven defendants (including two doctors) were charged with participation in a $51 million home health fraud scheme that allegedly recruited Medicare beneficiaries by offering cash and other incentives for their Medicare information that was then used to bill medically unnecessary home health services. Six people (including one doctor) were also charged with over $30 million in fraud in connection with a community mental health center, which is in addition to charges brought against the owners and operators of a related community mental health center who were allegedly involved in a $225 million fraud scheme charged in an earlier criminal indictment.

3. The Houston Allegations

Two people (a nurse and a social worker, who are brother and sister) were charged with fraud schemes involving $8.1 million in false billings for home health care by allegedly using patient recruiters to obtain Medicare beneficiary information that they then used to bill for services that were not medically necessary and not provided.

4. The Los Angeles Allegations

Thirteen people were charged in Los Angeles for their alleged roles in schemes to defraud Medicare of approximately $23 million. Three of those defendants allegedly billed Medicare for more than $8.7 million in fraudulent billing for DME by paying illegal kick-backs to patient recruiters to bribe Medicare beneficiaries to participate in the scheme. It is alleged that once the Medicare beneficiaries provided their Medicare information to the recruiters, doctors and medical clinics conspiring with these defendants wrote prescriptions for medically unnecessary power wheelchairs, which they sold to the defendants for illegal kick-backs.

5. The Detroit Allegations

Eighteen defendants (including two doctors, a physician’s assistant, and two therapists) were charged for their roles in alleged fraud schemes involving approximately $49 million in false claims for medically unnecessary services, including home health, psychotherapy, and infusion therapy. Three of these defendants were charged in a $12 million scheme where they allegedly held themselves out to be licensed physicians, which they were not, and signed prescriptions for drugs and signed documents about purported psychotherapy they provided.

6. The Tampa Allegations

Nine defendants were charged with participation in allegedly fraudulent schemes ranging from pharmacy fraud to health care-related money laundering. Four of the defendants were charged for their alleged roles in establishing and operating four supposed healthcare clinics in Tampa which they allegedly used to steal more than $2.5 million from Medicare for surgical procedures to treat patients with high blood pressure by collapsing veins in their legs, which were never performed.

7. The Chicago Allegations   

Seven people in Chicago (including two doctors) were charged with various health care fraud schemes.

8. The Brooklyn Allegations

Four people (including two doctors) were charged in Medicare fraud schemes involving $9.1 million in false claims. Three other people were allegedly involved in a $15 million fraud scheme where massages by unlicensed therapists were billed to Medicare as physical therapy.

Source

If you aware of a possible Medicare fraud scheme or Medicaid fraud scheme in your state, you may wish to consult with a local medical malpractice attorney to determine if you can file a False Claims Act federal lawsuit that may entitle you to receive a portion of the amount recovered as a result of your efforts (called a qui tam action)..

Click here to visit our website or telephone us toll-free at 800-295-3959 to be connected with medical malpractice lawyers (qui tam lawyers) in your state who may agree to investigate whether you have the basis for filing a False Claims Act lawsuit that may result in you receiving a portion of the recovery.

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This entry was posted on Wednesday, May 15th, 2013 at 10:20 am. Both comments and pings are currently closed.

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