Federal authorities brought charges on Wednesday against over 300 people who were allegedly involved in a Medicare fraud scheme worth $900 million in false billings. The enforcement action is being lauded as the largest Medicare fraud takedown in the history of the country, exceeding the previous record set last year when 243 defendants faced charges for a combined $712 million in false billings.
Wednesday’s takedown was headed by the Medicare Fraud Strike Force, which conducted a nationwide sweep in 36 federal districts that resulted in civil and criminal charges against 301 individuals. Sixty-one doctors, nurses, and other medical professionals were among those charged for participating in the widespread Medicare fraud scheme. Twenty-three Medicaid Fraud Control Units also participated in the takedown.
Charges in the Largest Medicare Fraud Scheme in U.S. History
Those implicated in the Medicare fraud scheme have been accused of a wide range of healthcare-related crimes, including aggravated identity theft, money laundering, conspiracy to commit health care fraud, and violations of anti-kickback statutes. The charges stem from a number of different schemes involving various medical treatments and care, including home health care, physical and occupational therapy, psychotherapy, durable medical equipment, and prescription drugs.
Court documents show that defendants submitted for Medicare and Medicaid reimbursement based on treatments that were either medically unnecessary or never provided. More than 60 of the individuals charged were arrested in connection with Medicare Part D fraud, the prescription drug program for Medicare.
In many of the cases, patient recruiters, Medicare beneficiaries, and other conspirators were allegedly paid cash in exchange for patient information that health care providers could then use to submit false bills to Medicare and Medicaid. According to the Justice Department, the total amount of false bills submitted reached approximately $900 million.
Where Were the Accused Operating?
Southern District of Florida – According to the DOJ, 100 defendants from the Southern District of Florida were charged in connection with fraud schemes worth an estimated $220 million. The schemes revolved around pharmacy fraud, home health care fraud and mental health services fraud. In one Medicare fraud scheme cited by the DOJ, nine individuals were allegedly responsible for submitting false bills to Medicare on behalf of six different Miami-area clinics providing home health care services. These bills were for services not considered medically necessary and allegedly based on kickbacks paid by the perpetrators. In total, Medicare paid out over $24 million as a result of the scheme.
Central District of California – A total of 22 defendants were charged for schemes to defraud Medicare of an estimated $162 million. In one example, a doctor allegedly submitted false claims to Medicare that resulted in the government paying nearly $12 million for medically unnecessary services.
Southern District of Texas – Authorities say 24 individuals submitted false claims worth over $146 million. One physician with the highest amount of patient referrals for home health care services in the district was charged with participating in schemes to bill Medicare for services that were often not provided.
Northern District of Texas – Eleven people were charged in cases worth over $47 million in alleged Medicare fraud. One area physician was allegedly involved in a Medicare fraud scheme where unlicensed individuals provided medical services that were billed as if the doctor had performed them himself.
Eastern District of Michigan – Authorities charged 19 people for their alleged roles in Medicare fraud schemes totaling an estimated $114 million. Defendants have been accused of fraud, paying kickbacks, drug distribution schemes, and money laundering.
Eastern District of New York – Ten people were charged in six cases. Five of the defendants were allegedly involved in a health care fraud scheme worth over $86 million for false claims related to physical and occupational therapy paid by both Medicare and Medicaid.
Middle District of Florida – Authorities charged 15 people for their alleged involvement in Medicare fraud schemes that involved intravenous prescription drug fraud and pharmacy fraud. The schemes resulted in $17 million in false billing.
Northern District of Illinois – Six were charged in connection with Medicare fraud claims worth over $12 million.
Eastern District of Louisiana – Three people were charged for their roles in a Medicare fraud scheme and a wire fraud scheme involving a defunct home health care provider.
The enforcement action also involved cases brought by 26 U.S. Attorney General Offices in North Carolina, Georgia, Texas, West Virginia, Washington D.C., Alabama, Minnesota, and Louisiana.
Medicare Fraud Whistleblower
Fraud accounts for an estimated 10 percent of all Medicare and Medicaid expenditures on an annual basis. Medicare fraud costs taxpayers billions and drives up the cost of health care for everyone.
As evidenced by today’s enforcement action, the government has the ability to catch criminals who seek to defraud Medicare. But resources dedicated to finding and prosecuting fraudsters are still quite limited. This is why whistleblowers are so vital in protecting the integrity of Medicare and Medicaid.