Medicare Fraud Strike Force Takedown: 90 Individuals Charged; $260 Million in False Billings

On May 13, 2014, the Department of Justice (DOJ) and Department of Health and Human Services (HHS) announced that the most recent Medicare Fraud Strike Force nationwide takedown resulted in charges filed against 90 individuals related to their alleged involvement in Medicare fraud schemes totaling approximately $260 million in false billings. The takedown was part of the Medicare Fraud Strike Force’s Health Care Fraud Prevention & Enforcement Action Team (HEAT), a joint DOJ-HHS initiative aimed a preventing and deterring fraud and enforcing current anti-fraud laws.

The DOJ press release indicates that the defendants charged in the takedown were allegedly involved in a variety of fraud-related crimes: conspiracy to commit healthcare fraud, violations of the anti-kickback statutes and money laundering. The alleged fraud schemes involved various medical treatments and services including home health care services, mental health services, psychotherapy, physical and occupational therapy, durable medical equipment and pharmacy. The press release explains that the alleged schemes typically involved submission of claims to Medicare for treatment or services that were medically unnecessary and/or were never provided.  A number of cases involve patient recruiters, Medicare beneficiaries and other individuals who were paid cash kickbacks in exchanged for Medicare beneficiary information so fraudulent claims for services could then be submitted to Medicare for payment. Twenty-seven of the 90 individuals charged were medical professionals, including 16 physicians.

Defendants were charged in connection with the Strike Force takedown in Miami, Houston, Los Angeles, Detroit, Tampa, and Brooklyn. In Detroit, seven individuals were charged related to fraud schemes totaling approximately $30 million for medically unnecessary services which reportedly included home health, psychotherapy and infusion therapy.

Since its inception, the Medicare Fraud Strike Force has charged almost 1,900 individuals who falsely billed Medicare almost $6 billion collectively. The Centers for Medicare and Medicaid Services (CMS), working together with HHS-OIG has also suspended Medicare enrollments of high-risk providers in five Strike Force locations and has removed more than 17,000 providers from the Medicare program.

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