Medicare Fraud: DOJ Charges 243 People over $712M False Billing

The United States Department of Justice (DOJ) filed charges against 243 people including doctors, nurses, home health care providers, and other licensed medical practitioners, who participated in Medicare fraud schemes involving $712 million in false billing.

Attorney General Loretta Lynch and Secretary Sylvia M. Burwell of the Department of Health and Human Services (HHS) announced the nationwide Medical Fraud takedown in Washington today.
The largest Medicare fraud takedown

The Medicare Fraud Strike Force, a joint initiative of the DOJ and HHS led the coordinated takedown in 17 federal districts across the country. It was the largest criminal health care fraud takedown in the history of the DOJ.

In a statement, Atty. General Lynch said the people involved in the Medicare fraud were “accused of an array of serious crimes ranging from conspiracy to commit health care fraud to money laundering.”

“They billed for equipment that wasn’t provided, for care that wasn’t needed, and for services that weren’t rendered,” said Atty. General Lynch.

She added that the “owners of a mental health facility in Miami billed for intensive psychotherapy sessions that resulted in tens of millions in reimbursement for doctors that based on treatment that was nothing more than moving patients to different locations.” Atty. General Lynch described it as one of the egregious allegations of exploitation of both the Medicare systems and vulnerable patients.

Patients were threatened to keep them bound to the Medicare fraud scheme

According to the Atty. General 50 of the defendants were charged with fraud related to the Medicare prescription drug benefits program known as Part D.

She noted that the owner of a healthcare provider in Florida received $1.6 million from Medicare Part D for prescription drugs that were never purchased or dispensed.

A doctor in Michigan was charged for allegedly prescribing unnecessary narcotic pain medications to patients in exchange for the use of their identification to make false billings. “Patients who attempted to withdraw from the scheme were threatened with loss of prescription narcotics,” said Atty. General Lynch. She emphasized that the doctors use the patients’ addiction to keep them bound to their scheme.

Atty. General Lynch emphasized that the action of the DOJ and HHS “represents the first large-scale focus on Medicare Part D fraud and demonstrates an expanded federal focus” on the problem.
Since the establishment of the Medicare Fraud Strike Force, the DOJ already charged more than 2,300 people, accounting for more than $7 billion in Medicare losses.

Secretary Burwell emphasized, “This Administration is committed to fighting fraud and protecting taxpayer dollars in Medicare and Medicaid. “This takedown adds to the hundreds of millions we have saved through fraud prevention since the Affordable Care Act was passed.”

The government already recovered $3.3 billion in taxpayer dollars in the fiscal year ended Septemeber 30, according to a report last March.