HHS Uncovers False Medicare Billing $712 Million

Newly announced fraud charges against 243 individuals involved schemes of approximately $712 million worth in false billings, according to an announcement by HHS. CMS also suspended a number of providers.

The defendants, which include 46 doctors, nurses, and other licensed medical professionals who allegedly participated in the schemes, are charged with various healthcare fraud-related crimes, such as violations of the anti-kickback statutes, money laundering, and aggravated identity theft. More than 44 of those arrested are being charged with fraud related to Medicare Part D.

“The defendants charged include doctors, patient recruiters, home healthcare providers, pharmacy owners, and others,” Attorney General Loretta E. Lynch, said in a statement. “They billed for equipment that wasn’t provided, for care that wasn’t needed, and for services that weren’t rendered.”

In Miami, 73 defendants were charged for schemes involving approximately $263 million in false billings for home healthcare, mental health services, and pharmacy fraud. In Houston and McAllen, 22 people were charged for more than $38 million in alleged fraud. There were another 16 defendants charged in Detroit; 11 in New Orleans; 9 in Brooklyn, NY; 8 in Los Angeles; 7 in Dallas; and 5 in Tampa.

“The people charged in this case targeted the system each of us depends on in our most vulnerable moments,” FBI Director James Comey said. “Healthcare fraud is a crime that hurts all of us and each dollar taken from programs that help the sick and the suffering is one dollar too many.”

The takedowns were led by the Medicare Fraud Strike Force, which operates in 9 locations and is a part of the Health Care Fraud Prevention and Enforcement Action Team. Since the Strike Force was created in 2007, it has charged more than 2300 defendants who have falsely billed Medicare a total of $7 billion over the years.

“This takedown adds to the hundreds of millions we have saved through fraud prevention since the Affordable Care Act was passed,” HHS Secretary Sylvia Mathews Burwell said. “With increased resources that have allowed the Strike Force to expand and new tools, like enhanced screening and enrollment requirements, tough new rules and sentences for criminals, and advanced predictive modeling technology, we have managed to better find and fight fraud as well as stop it before it starts.”