$452 Million In False Medicare Billing Alleged By Prosecutors

One hundred and seven people – including doctors, nurses and other licensed medical professionals – have been charged for their alleged participation in Medicare fraud schemes involving approximately $452 million in false billing. The coordinated takedown involved the highest amount of allegedly false Medicare billings in a single takedown in Medicare Fraud Strike Force history. 

The Department of Health and Human Services also suspended or took other administrative action against 52 providers following what prosecutors say was a data-driven analysis and credible allegations of fraud. 
 
More than 500 law enforcement agents from the FBI, HHS-Office of Inspector General (HHS-OIG), multiple Medicaid Fraud Control Units, and other state and local law enforcement agencies participated in the takedown. In addition to making arrests, agents also executed 20 search warrants in connection with ongoing strike force investigations.  
 
The defendants are accused of various health care fraud-related crimes, including conspiracy to commit health care fraud, health care fraud, violations of the anti-kickback statutes and money laundering.  The charges are 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.   
 
According to court documents, the defendants allegedly participated in schemes to submit claims to Medicare for treatments that were medically unnecessary and oftentimes never provided. In many cases, court documents allege that patient recruiters, Medicare beneficiaries and other co-conspirators were paid cash kickbacks in return for supplying beneficiary information to providers, so that the providers could submit fraudulent billing to Medicare for services that were medically unnecessary or never provided. 
 
Collectively, the doctors, nurses, licensed medical professionals, health care company owners and others charged are accused of conspiring to submit a total of approximately $452 million in fraudulent billing.
 
In Miami, a total of 59 defendants, including three nurses and two therapists, were charged for their alleged participation in various fraud schemes involving 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 today.   In one case, 10 defendants were charged for allegedly participating in a fraud scheme at Health Care Solutions Network, which led to approximately $63 million in fraudulent billing for community mental health center (CMHC) services. Court documents allege that therapists at Health Care Solutions Network were instructed to alter notes and other medical documents to justify CMHC services for beneficiaries who did not need the services.  
 
Seven individuals were charged in Baton Rouge, La., for allegedly participating in a fraud scheme involving $225 million in false claims for CMHC services. The case represents the largest CMHC-related scheme ever prosecuted by the Medicare Fraud Strike Force.   According to court documents, the defendants recruited beneficiaries from nursing homes and homeless shelters, some of whom were drug addicted or mentally ill, and provided them with no services or medically inappropriate services.

In Houston, nine individuals, including one doctor and one nurse, were charged with fraud schemes involving a total of $16.4 million in false billings for home health care and ambulance services.   According to court documents, the owners and operators of four different ambulance companies billed Medicare for ambulance rides that were medically unnecessary.
 
Eight defendants, including two doctors, were charged in Los Angeles for their alleged roles in schemes to defraud Medicare of approximately $14 million.  In one case, two individuals allegedly billed Medicare for more than $8 million in fraudulent billing for DME.
 
In Detroit, 22 defendants, including four licensed social workers, were charged for their alleged roles in fraud schemes involving approximately $58 million in false claims for medically unnecessary services, including home health, psychotherapy and infusion therapy.  
 
In Tampa, Fla., a pharmacist was charged with illegal diversion of controlled substances.   One defendant was charged in Chicago for his alleged role in a scheme to submit approximately $1 million in false billing to Medicare for psychotherapy services.
 
Prosecutors say that since their inception in March 2007, strike force operations in nine locations have charged more than 1,330 defendants who collectively have falsely billed the Medicare program for more than $4 billion.