HHS Fraud Strikeforce Orchestrates National Takedown in 7 Cities

Charges of fraud claims totaling almost a half million dollars were filed as 107 individuals in the medical profession in seven major cities across the country in what the Justice Department states is the highest in a single raid in the history of a federal strike force combating rising fraud in the medical industry. Doctors, nurses and social were charged in what federal officials inWashingtoncalled a “nationwide takedown” of medical professionals accused of fraudulently billing Medicare out of approximately $452 million.

 Attorney General Eric Holder and Health and Human Services (HHS) Secretary Kathleen Sebelius made the announcement, calling it a “nationwide takedown” by Medicare Fraud Strike Force operations. They were joined in the announcement by Assistant Attorney General Lanny A. Breuer of the Justice Department’s Criminal Division, FBI Deputy Director Sean Joyce, Deputy Inspector General for Investigations Gary Cantrell of the HHS Office of Inspector General (HHS-OIG) and Dr. Peter Budetti, Deputy Administrator for Program Integrity of the Centers for Medicare and Medicaid Services (CMS).

 The take down involved the highest amount of false Medicare billings in a single takedown in strike force history. In addition to the charges filed, HHS either suspended or took other administrative action against 52 providers following a data-driven analysis and credible allegations of fraud. The charges involved everything from conspiracy to commit health care fraud, health care fraud, violations of the anti-kickback statutes and money laundering and were based on a variety of alleged fraud schemes involving various medical treatments and services such as home health care, mental health services, psychotherapy, physical and occupational therapy, durable medical equipment (DME) and ambulance services.  

 “The results we are announcing today are at the heart of an Administration-wide commitment to protecting American taxpayers from health care fraud, which can drive up costs and threaten the strength and integrity of our health care system,” said Attorney General Holder.  “We are determined to bring to justice those who violate our laws and defraud the Medicare program for personal gain.  As today’s takedown reflects, our ongoing fight against health care fraud has never been more coordinated and effective.”

 “Today’s arrests send a strong message to criminals that the consequences of committing Medicare fraud are serious,” said HHS Secretary Sebelius. “In addition to these arrests, we used new authority from the health care law to stop all future payments to 52 health care providers suspected of fraud before they are ever made. Today’s actions are another example of how the Affordable Care Act is helping the Obama Administration fight fraud and strengthen the Medicare program.”

 One set of charges came out of the Los Angeles area, where eight people, including two doctors, were charged with fraudulently billing about $20 million for services never provided. The owner of healthcare equipment provider was charged with billing Medicare for power wheelchairs that were never purchased. A home health agency allegedly paid kickbacks to recruiters to find patients who were healthy and then have doctors knowingly write false prescriptions for them.

 In Miami, a total of 59 defendants, including three nurses and two therapists, were charged for their participation in various fraud schemes which involved a total of $137 million in false billings for home health care, mental health services, occupational and physical therapy, DME and HIV infusion.  Two of these 59 defendants were originally charged in April 2012 but were indicted on additional charges.  In one case, 10 defendants were charged with instructing therapists to alter notes and other medical documents to justify medical services for beneficiaries who did not need the services.

 Assistant Atty. Gen. Lanny Breuer, head of the Justice Department’s criminal division, said the arrests, fourth in a series of Medicare fraud takedowns over the last two years, served as another warning to future scammers. “Medicare is an attractive target for criminals,” Breuer said, “but it should also remind those criminals that they risk prosecution and prison time every time they submit a false claim.” 

 The other cities involved in the takedown were Tampa,  Houston, Baton Rouge, Detroit and Chicago. Last year, the federal government charged 1,430 people with healthcare fraud, up from 797 in 2008, according to the Health and Human Services Department. The agency also reported revoking the eligibility of more than 60,000 Medicare and Medicaid providers and suppliers and recovering $4.1 billion in fraudulent claims. The charges are just another large piece of proof to show that the new health care law, the Affordable Care Act, significantly increased HHS’s ability combat fraud.