Healthcare News & Insights

Medicare Fraud Strike Force: 89 people arrested for $220 in false claims

In its sixth coordinated takedown, the Medicare Fraud Strike Force charged 89 people in eight cities for their alleged participation in Medicare fraud schemes that netted approximately $223 million in false billings. Among those 89 individuals were doctors, nurses and other licensed medical professionals.

138074622The defendants are accused of conspiracy to commit healthcare fraud, violations of the anti-kickback statutes and money laundering.

Court documents allege they participated in schemes to submit claims to Medicare for treatments that weren’t medically necessary or were never provided.  It’s also alleged that patient recruiters, Medicare beneficiaries and others were paid cash for providing beneficiary information to providers, so they could use it for their billing scams.

Since its creation in 2007, the Strike Force has been targeting key areas — among them, the cities listed below — that are hotbeds for Medicare fraud.

Miami

Miami is known for major Medicare scams and a total of 25 defendants, including two nurses, were charged for their part in a number of fraud schemes which totaled $44 million. These cases involved false billings for home health care, mental health services, occupational and physical therapy, durable medical equipment and HIV infusion.

Three of the Miami defendants were charged for participating in a $20 million home health fraud scheme involving Trust Care Health Services, a home health agency. Court documents allege that the lead defendant purchased two Lamborghinis, a Ferrari and a Bentley with the money he got from the scam.

Baton Rouge, LA

The Baton Rouge Strike Force rounded up and charged:

  • Five people, two of whom were doctors in New Orleans,  for participating in a $51 million home health fraud scheme where they allegedly recruited beneficiaries, offering cash and other incentives in exchange for their Medicare information, which was used to bill medically unnecessary home health services, and
  • Six others, one of whom was a doctor, for their involvement in a $30 million fraud scheme connected to the mental health center Shifa Texas.

Houston

Two people in Houston, including a nurse and a social worker, were charged with fraud schemes involving a total of $8.1 million in false billings for home health care.  The brother and sister duo allegedly used patient recruiters to obtain Medicare beneficiary information they used to bill for services that weren’t medically necessary and not provided.

Los Angeles

A Medicare scheme that netted approximately $23 million also netted 13 suspects. In one case, three individuals allegedly billed Medicare for more than $8.7 million in fraudulent billing for durable medical equipment (DME). According to the indictment, the defendants allegedly paid kickbacks to patient recruiters as bribes to participate in the scheme. Once they had the Medicare info, the doctors allegedly wrote prescriptions for medically unnecessary power wheelchairs, which they sold to the defendants for illegal kickbacks.

Detroit

Two doctors, a physician’s assistant and two therapists were part of the 18-people group charged with $49 million in false claims for medically unnecessary services, including home health, psychotherapy and infusion therapy.  In one case, three individuals were charged in a $12 million scheme where they allegedly claimed to be licensed physicians – they weren’t – and signed prescriptions for drugs and documents about supposed psychotherapy they provided.

Tampa, FL

A variety of schemes, ranging from pharmacy fraud to healthcare-related money laundering, nabbed nine people in Tampa. In one case, four individuals were charged for their alleged roles in establishing and operating four alleged healthcare clinics in Tampa, FL – Palmetto General Health Care, Inc.; United Healthcare Center, Inc.; New Imaging Center, Inc.; and Lord Physical Rehabilitation Center, Inc. According to a press release from the Department of Justice, they used the centers to steal more than $2.5 million from Medicare for surgical procedures that were never performed.

Chicago

Two doctors were among the seven people charged with a number of healthcare fraud Schemes in Chicago.

Brooklyn, NY

Finally, four individuals, including two doctors, were charged in fraud schemes involving $9.1 million in false claims. In one case, three additional people were allegedly involved in a $15 million scheme where massages by unlicensed therapists allegedly were billed to Medicare as physical therapy.

Strike Force not done

While the accused are presumed innocent until proven guilty, you’d better believe the Medicare Fraud Strike Force teams, comprised of attorneys from numerous government agencies, will do all they can to prosecute those individuals who are guilty.

In these national take-downs alone, nearly 600 individuals have been charged in connection with schemes involving $2 billion in fraudulent billings. And since the Medicare Fraud Strike Force’s inception, the team has charged more than 1,500 defendants, who collectively have falsely billed Medicare for more than  $5 billion.

 

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