May 14, 2014

16 doctors among 90 arrested in Medicare fraud sweep

Daily Briefing

    A federal task force on Tuesday arrested 90 people—including 27 doctors, nurses, and other health care providers—charged with generating $260 million in fraudulent Medicare billings, officials report.

    The arrests took place in six cities, and more than half of the people arrested were apprehended in Florida.

    Arrests, sanctions don't stop doctors from getting Medicare dollars

    The charges included conspiracy to commit health care fraud, money laundering, and violations of the anti-kickback statutes. Those charges are based on alleged fraud schemes that involved home health care, mental health services, psychotherapy, physical therapy, pharmacy fraud, and more:   

    • In Miami, 50 individuals were arrested for their alleged participation in schemes involving $65.5 million in false billings for mental health services, home health care, and pharmacy fraud. In one case, two individuals were charged in a $23 million kickback and laundering scheme in which defendants paid kickbacks to a pharmacy owner for beneficiary information that was used to bill for drugs that were never dispensed.

    • In Tampa, Fla., seven people were charged for their role in fraud schemes.

    • In Houston, 11 people were charged, including five doctors in the Houston area who were paid to approve home health care services that were unnecessary and often never provided.

    • In Los Angeles, eight individuals were charged for their involvement in schemes involving about $32 million in claims for medically unnecessary services. In one scheme, a doctor was accused of causing nearly $24 million in losses to Medicare through fraudulent billing and referrals for home health services and medical equipment, including more than 1,000 power wheelchairs. 

    • In Detroit, seven people were charged for their involvement in fraud schemes.

    • In Brooklyn, officials announced an indictment against a physician charged in an $85 million scheme involving billings for surgeries that were never performed. Officials also charged six other individuals, including a doctor connected with a $14.4 million scheme in which beneficiaries were recruited and Medicare was charged for unnecessary tests and services.

    "Among the defendants charged were 27 medical professionals, including 16 doctors. The crimes charged represent the face of health care fraud today," says Acting Assistant Attorney General David O'Neil.

    The arrests represent the seventh major fraud crackdown by the Medicare Fraud Strike Force, which the Department of Justice and HHS created in 2007. Overall, the strike force has charged almost 1,900 defendants for fraudulently billing Medicare for almost $6 billion (DOJ release, 5/13; AP/Modern Healthcare, 5/14 [subscription required]; Carreyrou/Stewart, Wall Street Journal, 5/13; Fagenson, Reuters, 5/13).

    More from the Medicare Fraud Strike Force

    This is the seventh major bust for the task force. Read about some of the earlier fraud sweeps:

    Make sense of the changing fraud and abuse landscape

    The Obama Administration has taken several steps to intensify its enforcement activities, including recent amendments to the False Claims Act and unprecedented coordination between the Department of Justice and the Department of Health and Human Services.

    In this webconference, we help you make sense of the changing fraud and abuse landscape.

    More from today's Daily Briefing
    1. Current Article16 doctors among 90 arrested in Medicare fraud sweep

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