Gov. Task Force Charges 91 Healthcare Providers for $430 Million Billing Fraud

The Medicare Fraud Strike Force operations has busted 91 individuals—among them doctors, nurses, and other licensed medical professionals—for their alleged participation in Medicare fraud schemes involving approximately $429.2 million in false billing, Attorney General Eric Holder and Health and Human Services (HHS) Secretary Kathleen Sebelius recently announced.

The bulk of the fraudulent billing, at more than $230 million of the indictments related to the charges, was for home health care fraud, with more than $100 million in mental health care fraud and more than $49 million in ambulance transportation fraud, along with millions more in other various fraud. 

“Today’s enforcement actions reveal an alarming and unacceptable trend of individuals attempting to exploit federal health care programs to steal billions in taxpayer dollars for personal gain,” said Attorney General Holder.  “Such activities not only siphon precious taxpayer resources, drive up health care costs, and jeopardize the strength of the Medicare program—they also disproportionately victimize the most vulnerable members of society, including elderly, disabled and impoverished Americans.”

At the time of the Oct. 4 announcement, dozens of those charged with the alleged fraud schemes had been arrested or surrendered in the previous 24 hours as indictments were unsealed across the country. HHS also suspended or took administrative action against 30 health care providers following a data-driven analysis and based upon credible allegations of fraud, says the department.

The various charges against the defendants include conspiracy to commit health care fraud, health care fraud, violations of the anti-kickback statutes, and money laundering. The alleged fraud schemes involved various medical treatments and services such as home health care, mental health services, psychotherapy, physical and occupational therapy, durable medical equipment, and ambulance services.

The defendants allegedly participated in schemes to submit Medicare claims for treatments that were either medically unnecessary, or were never provided, according to court documents. In some cases, patient recruiters, Medicare beneficiaries, and other co-conspirators were paid cash kickbacks in return for supplying beneficiary information to providers, allowing the providers to submit fraudulent reimbursement claims to Medicare for services that weren’t necessary or were never provided.

“Today’s coordinated actions represent one of the largest Medicare fraud takedowns in Department of Justice history, as measured by the amount of alleged fraudulent billings,” said Assistant Attorney General Breuer.  “We have made it one of the Department’s missions to hold accountable those who abuse the Medicare program for personal profit.  And there are Medicare fraudsters in prisons across the country—some who will be there for decades—who can attest to our determination, and our effectiveness.”

Written by Alyssa Gerace

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