Attorney General Loretta E. Lynch and Department of Health and Human Services (HHS) Secretary Sylvia Mathews Burwell have announced a nationwide sweep led by the Medicare Fraud Strike Force in 36 federal districts, resulting in criminal and civil charges against 301 individuals, including 61 doctors, nurses, and other licensed medical professionals, for their alleged participation in health care fraud schemes involving approximately $900 million in false billings. In addition, the HHS Centers for Medicare and Medicaid Services (CMS) is suspending payment to a number of providers using its suspension authority provided in the Patient Protection and Affordable Care Act. The coordinated takedown is the largest in history, both in terms of the number of defendants charged and the loss amount.
The defendants are charged with various health care fraud-related crimes, including conspiracy to commit health care fraud, violations of the antikickback statutes, money laundering, and aggravated identity theft. The charges are based on a variety of alleged fraud schemes involving various medical treatments and services, including home health care, psychotherapy, physical and occupational therapy, durable medical equipment, and prescription drugs. More than 60 of the defendants arrested are charged with fraud related to the Medicare prescription drug benefit program known as Part D, which is the fastest-growing component of the Medicare program.
According to court documents, the defendants allegedly participated in schemes to submit claims to Medicare and Medicaid for treatments that were medically unnecessary and often never provided. In many cases, patient recruiters, Medicare beneficiaries, and other co-conspirators were allegedly paid cash kickbacks in return for supplying beneficiary information to providers, so that the providers could then submit fraudulent bills to Medicare. Collectively, the doctors, nurses, licensed medical professionals, health care company owners, and others charged are accused of submitting approximately $900 million in fraudulent billing. Some examples follow:
Since January 2009, the Justice Department’s Civil Division, along with U.S. Attorney’s offices around the country, has recovered more than $29.9 billion through False Claims Act cases, with more than $18.3 billion of that amount recovered in cases involving fraud against federal health care programs.
Source: U.S. Department of Justice; June 22, 2016.