301 individuals are charged with about $900 million worth of false billing
Cases involve Medicare and Medicaid fraud
The Justice Department announced Wednesday it’s charging hundreds of individuals across the country with committing Medicare fraud worth hundreds of millions of dollars.
It’s the largest takedown in history – both in terms of the number of people charged and the loss amount, according to the Justice Department.
The majority of the cases being prosecuted involve separate fraudulent billings to Medicare, Medicaid or both for treatments that were never provided.
In one case, a Detroit clinic that was actually a front for a narcotics diversion scheme billed Medicare for more than $36 million, the Justice Department said.
The takedown: By the numbers
$900 million in false billing$38 million sent from Medicare and Medicaid to one clinic to carry out medically unnecessary treatments$36 million billed to Medicare by a Detroit clinic that was actually a front for a narcotics diversion scheme1,000 law enforcement personnel involved301 defendants charged across the United States61 of those charged are medical professionals36 federal judicial districts involved28 of those charged are doctors
A doctor in Texas has been charged with participating in schemes to bill Medicare for “medically unnecessary home health services that were often not provided.”
And in Florida, the owner of several infusion clinics is accused by the federal government of defrauding medicare out of over $8 million for a scheme involving the reimbursement for expensive intravenous drugs that were never actually purchased and never given to patients.
“Health care fraud is not an abstract violation or benign offense. It is a serious crime,” Attorney General Loretta Lynch said. “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 defendants are charged with a numerous crimes, including conspiracy to commit health care fraud, violations of anti-kickback statutes, money laundering and aggravated identity theft.
The numbers from the case are staggering.
The Justice Department says that 301 people across the country have been charged with about $900 million in false billing – both records for the Medicare Fraud Strike Force, which carried out the “unprecedented nationwide sweep.”
“These criminals target the most vulnerable in our society by taking money away from the care of the elderly, children and disabled,” said FBI Associate Deputy Director David Bowdich.
Defendants in Florida are charged with carrying out more than $200 million worth of fraud, while individuals in California, Texas and Michigan are charged with committing more than $100 million worth of fraud in each state.
The strike force, part of a joint initiative between the Departments of Justice and Health and Human Service, was formed in 2007. To date it has carried out takedowns resulting in more than 1,000 people being charged with committing over $3.5 billion in health care fraud.
Home health fraud
Much of the fraud involved home health care agencies – and those types of services have been identified as particularly vulnerable to fraud, according to the HHS Department’s inspector general.
Medicare home health benefit covers skilled nursing care, home-based assistance and therapeutic services for qualifying individuals who are home-bound.
In conjunction with the arrests, the HHS inspector general released a study saying that more than $10 billion was made in improper payments in home health care in the 2015 financial year.
“Home health has long been recognized as a program area vulnerable to fraud, waste, and abuse,” it said. “Home health fraud in Medicare continues to warrant scrutiny and attention.”
It also identified 27 so-called “hotspots” in 12 places where it believes home health care fraud is committed more often.
Part D fraud
Lynch said one of the new trends law enforcement noticed was fraud involving the Medicare Part D, the prescription drug program.
“We saw new evidence of identity theft, including the use of stolen doctors’ IDs to prepare fake prescriptions,” she said.
More than 60 of those who were arrested were charged with fraud related to Part D, according to the Justice Department.
The HHS inspector general’s office said that one in three Part D beneficiaries received commonly abused opioids last year, a trend it called concerning.
“Misuse of opioids not only has serious financial costs but also human costs, including deaths from overdoses,” HHS said. “These continuing high rates provide further evidence of this crisis facing our Nation.”