Largest U.S. Health Care Fraud Takedown Announced

162017_132140396847214_292624_nOn June 22, 2016, the U.S. Attorney and the U.S. Department of Health and Human Services (“HHS”) announced the largest nationwide health care fraud sweep to date, in terms of the number of defendants charged and the loss amount, led by the Medicare Fraud Strike Force in 36 federal districts. The health care fraud sweep resulted in criminal and civil charges against 301 individuals, including 61 doctors, nurses, and other licensed medical professionals, for their alleged participation in health care fraud schemes involving approximately $900 million in false billings to federal health care programs.

The defendants are charged with various health care fraud-related crimes, including conspiracy to commit health care fraud, violations of the anti-kickback statutes, money laundering, and aggravated identity theft, based on a variety of alleged fraud schemes involving various medical treatments and services. The health care fraud schemes included home health care, psychotherapy, physical and occupational therapy, durable medical equipment (“DME”), and prescription drugs. More than 60 of the defendants arrested are charged with fraud related to the Medicare prescription drug benefit program known as Part D, which is the fastest-growing component of the Medicare program overall.

The defendants arrested allegedly participated in schemes to submit claims to Medicare and Medicaid for treatments that were medically unnecessary and often never provided.  In many cases, patient recruiters, Medicare beneficiaries, and other co-conspirators were allegedly paid cash kickbacks in return for supplying beneficiary information to providers so that the providers could then submit fraudulent bills to Medicare for services that were medically unnecessary or never performed. Collectively, the doctors, nurses, licensed medical professionals, health care company owners, and others charged are accused of submitting a total of approximately $900 million in fraudulent billing.

In discussing this nationwide health care fraud sweep, the U.S. Attorney stated, “As this takedown should make clear, health care fraud is not an abstract violation or benign offense – It is a serious crime. The wrongdoers that we pursue in these operations seek to use public funds for private enrichment. They target real people – many of them in need of significant medical care. They promise effective cures and therapies, but they provide none. Above all, they abuse basic bonds of trust – between doctor and patient; between pharmacist and doctor; between taxpayer and government – and pervert them to their own ends. The Department of Justice is determined to continue working to ensure that the American people know that their health care system works for them – and them alone.”

To date, nearly 1,200 individuals have been charged in national takedown operations, which have involved more than $3.4 billion in fraudulent billings.

The current takedown is the second time that districts outside of Medicare Fraud Strike Force locations participated in a national takedown, and they accounted for 82 defendants charged in the current takedown. In Florida, Iowa, South Dakota, Indiana, New York, Michigan, Oklahoma, Rhode Island, Louisiana, Pennsylvania, New Hampshire, Oregon, Kentucky, and Alaska, 49 defendants have been charged in criminal and civil actions with defrauding the Medicaid program and 57 sites were searched, pursuant to search warrants. These cases were investigated by each state’s respective Medicaid Fraud Control Units.

Source

If you have knowledge of Medicare or Medicaid fraud that has cost the Medicare or Medicaid health care programs money and you become a whistleblower, your information and efforts in assisting the U.S. to recover the illegal payments may entitle you to monetary compensation.

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This entry was posted on Saturday, July 2nd, 2016 at 5:16 am. Both comments and pings are currently closed.

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