Are Health Care Fraud Defendants Unsophisticated Criminals? No, Breuer Says

Assistant Attorney General Lanny A. Breuer spoke today at the American Health Lawyers Association and Health Care Compliance Association’s 2011 Fraud and Compliance Forum in Baltimore. He pointed out, among other things, that in Fiscal Year 2010, the DOJ collectively recovered $4 billion in health fraud cases, brought criminal health care fraud charges against 931 defendants – the most ever in a single fiscal year – and secured 726 convictions, also a record. 

One other issue that Breuer spoke about that we found particularly interesting was his analysis of whether “the defendants in these cases are unsophisticated criminals.” The answer is that they are not, but that rather they “cover nearly the entire spectrum of healthcare providers.”
 
As Breuer observed, the DOJ recently “charged a doctor in Detroit with allegedly billing Medicare for performing psychotherapy treatments more than 24 hours per day. He is also charged with billing the Medicare program for services provided to dead beneficiaries.  We also charged a supervisor at a community mental health center in Miami with threatening to evict residents of a boarding house he also managed, unless they attended the center. A registered nurse, mental health counselors, and other healthcare professionals were charged with participating in the same scheme, which allegedly resulted in the submission of over $50 million in fraudulent billings to Medicare.”
 
Breuer also pointed out that 10 days ago, “the owner of a mental health care company in Miami, who pleaded guilty to orchestrating a $205 million Medicare fraud scheme, was sentenced to 50 years in prison” and three days later, “the company’s co-owner was sentenced to 35 years in prison.” He added that in June, “a Miami doctor was sentenced to nearly 20 years in prison for his participation in a multi-million dollar HIV injection and infusion Medicare fraud scheme. In that case, the physician ordered unnecessary tests, signed medical analysis and diagnosis forms, and authorized treatments to make it appear that patients were receiving services reimbursable by Medicare when, in fact, they were not. He signed patient charts indicating that infusion treatments were medically necessary, when, in fact, they were not. In many cases, he had not even seen the patient whose chart he was signing. For his efforts to cheat Medicare out of millions of dollars in this way, he received $3,000 per week from one of his co-conspirators.”