Medicare Fraud strike force charges 89 individuals for approximately $223 million in false billing

[Oliver Crangle]

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News Release
FOR IMMEDIATE RELEASE
May 14, 2013
Contact: DOJ Press Office
202-415-2007
Medicare Fraud strike force charges 89 individuals for approximately
$223 million in false billing
Attorney General Eric Holder and Department of Health and Human
Services (HHS) Secretary Kathleen Sebelius announced today that a
nationwide takedown by Medicare Fraud Strike Force operations in eight
cities has resulted in charges against 89 individuals, including
doctors, nurses and other licensed medical professionals, for their
alleged participation in Medicare fraud schemes involving
approximately $223 million in false billings.
Attorney General Holder and Secretary Sebelius were joined in the
announcement by Acting Assistant Attorney General Mythili Raman of the
Justice Department’s Criminal Division, FBI Assistant Director Ron
Hosko, Inspector General Daniel R. Levinson of the HHS Office of
Inspector General (HHS-OIG) and Deputy Administrator and Director of
Centers for Medicare & Medicaid Services (CMS) Center for Program
Integrity Peter Budetti.
This coordinated takedown was the sixth national Medicare fraud
takedown in Strike Force history. In total, almost 600 individuals
have been charged in connection with schemes involving almost $2
billion in fraudulent billings in these national takedown operations
alone. The Medicare Fraud Strike Force operations are part of the
Health Care Fraud Prevention & Enforcement Action Team (HEAT), a joint
initiative announced in May 2009 between the Department of Justice and
HHS to focus their efforts to prevent and deter fraud and enforce
current anti-fraud laws around the country.
Since their inception in March 2007, Strike Force operations in nine
locations have charged more than 1,500 defendants who collectively
have falsely billed the Medicare program for more than $5 billion. In
addition, CMS, working in conjunction with HHS-OIG, are taking steps
to increase accountability and decrease the presence of fraudulent
providers.
The joint Department of Justice and HHS Medicare Fraud Strike Force is
a multi-agency team of federal, state and local investigators designed
to combat Medicare fraud through the use of Medicare data analysis
techniques and an increased focus on community policing.
Approximately 400 law enforcement agents from the FBI, HHS-OIG,
multiple Medicaid Fraud Control Units and other state and local law
enforcement agencies participated in the takedown.
“Today’s announcement marks the latest step forward in our
comprehensive efforts to combat fraud and abuse in our health-care
systems,” said Attorney General Holder. “These significant actions
build on the remarkable progress that the HEAT has enabled us to make
– alongside key federal, state, and local partners – in identifying
and shutting down fraud schemes. They are helping to deter would-be
criminals from engaging in fraudulent activities in the first place.
And they underscore our ongoing commitment to protecting the American
people from all forms of health-care fraud, safeguarding taxpayer
resources and ensuring the integrity of essential health-care
programs.”
“The Affordable Care Act has given us additional tools to preserve
Medicare and protect the tens of millions of Americans who rely on it
each day,” said Secretary Sebelius. “By expanding our authority to
suspend Medicare payments and reimbursements when fraud is suspected,
the law allows us to better preserve the system and save taxpayer
dollars. Today we’re sending a strong, clear message to anyone
seeking to defraud Medicare: You will get caught and you will pay the
price. We will protect a sacred trust and an earned guarantee.”
The defendants charged are accused of various health care fraud-
related crimes, including conspiracy to commit health care fraud,
violations of the anti-kickback statutes and money laundering. The
charges are based on a variety of alleged fraud schemes involving
various medical treatments and services, primarily home health care,
but also mental health services, psychotherapy, physical and
occupational therapy, durable medical equipment (DME) and ambulance
services.
According to court documents, the defendants allegedly participated in
schemes to submit claims to Medicare for treatments that were
medically unnecessary and often never provided. In many cases, court
documents allege that patient recruiters, Medicare beneficiaries and
other co-conspirators were paid cash kickbacks in return for supplying
beneficiary information to providers, so that the providers could then
submit fraudulent billing to Medicare for services that were medically
unnecessary or never performed. Collectively, the doctors, nurses,
licensed medical professionals, health care company owners and others
charged are accused of conspiring to submit a total of approximately
$223 million in fraudulent billing.
“We have made it part of our core mission at the Department of Justice
to hold accountable those who steal from the Medicare program to line
their own pockets,” said Acting Assistant Attorney General Raman.
“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.”
“We all feel the effects of health care fraud,” said FBI Assistant
Director Hosko. “It leads to higher health care costs and makes it
harder for seniors and those who are ill to get the care they need.
The FBI and our law enforcement partners are committed to preventing
and prosecuting health care fraud at all levels. But we need the
public’s help. Take the time to be aware of fraud and call law
enforcement if you see anything suspicious included in the billings to
your insurance, Medicare, or Medicaid or have any unusual encounters
with health care providers. We can work together to ensure your hard-
earned dollars are used to care for the sick and not to line the
pockets of criminals.”
“Taxpayers expect us to work harder and smarter, and that is exactly
what happened across the nation today,” said HHS Inspector General
Levinson. “In addition to the work of my agents and other federal,
state, and local law enforcement officials, investigators from nine
other IG offices joined us today. Working together we can break down
silos, pool expertise, reduce costs, and the successful result speaks
for itself.”
“Today’s takedown is the result of dedicated commitment to working
with our law enforcement partners to root out fraud in the Medicare
program,” said CMS Program Integrity Deputy Administrator Budetti.
“This collaboration has been strengthened by the Affordable Care Act,
which provided CMS with the tools it needs to stop the flow of money
while working to rid our programs of fraud, waste and abuse.”
In Miami, a total of 25 defendants, including two nurses, a paramedic
and a radiographer, were charged today and yesterday for their
participation in various fraud schemes involving a total of $44
million in false billings for home health care, mental health
services, occupational and physical therapy, DME and HIV infusion. In
one case, three defendants were charged for participating in a $20
million home health fraud scheme involving a home health agency, Trust
Care Health Services. Court documents allege that the defendants
bribed Medicare beneficiaries for their Medicare information, which
was used to bill for home health services that were not rendered or
that were not medically necessary. According to court documents, the
lead defendant spent much of the money from the scheme, and purchased
multiple luxury vehicles, including two Lamborghinis, a Ferrari and a
Bentley.
Eleven individuals were charged by the Baton Rouge Strike Force. Five
individuals were charged today, including two doctors, in New Orleans
by the Baton Rouge Strike force for participating in a different $51
million home health fraud scheme. According to court documents, the
defendants recruited beneficiaries, offering cash and other incentives
in exchange for their Medicare information, which was used to bill
medically unnecessary home health services. The Baton Rouge Strike
Force also announced a superseding indictment and an information
charging six individuals, including another doctor, with over $30
million in fraud in connection with a community mental health center
called Shifa Texas. These charges come on top of charges brought
against the owners and operators of Shifa Baton Rouge, a related
community mental health center which is at the center of an alleged
$225 million scheme charged in an earlier indictment.
In Houston, two individuals, including a nurse and a social worker,
were charged today with fraud schemes involving at total of $8.1
million in false billings for home health care. The defendants, who
are brother and sister, allegedly used patient recruiters to obtain
Medicare beneficiary information that they then used to bill for
services that were not medically necessary and not provided.
Thirteen defendants were charged in Los Angeles for their roles in
schemes to defraud Medicare of approximately $23 million. In one
case, three individuals allegedly billed Medicare for more than $8.7
million in fraudulent billing for DME. According to the indictment,
the defendants allegedly paid illicit kickbacks to patient recruiters
to bribe beneficiaries to participate in the scheme. Once the
individuals provided their Medicare information to recruiters, doctors
and medical clinics conspiring with the defendants allegedly wrote
prescriptions for medically unnecessary power wheelchairs, which they
sold to the defendants for illegal kickbacks.
In Detroit, 18 defendants, including two doctors, a physician’s
assistant and two therapists, were charged for their roles in fraud
schemes involving approximately $49 million in false claims for
medically unnecessary services, including home health, psychotherapy
and infusion therapy. In one case, three individuals were charged in
a $12 million scheme where they allegedly held themselves out to be
licensed physicians – which they were not – and signed prescriptions
for drugs and documents about purported psychotherapy they provided.
In Tampa, nine individuals were charged in a variety of schemes,
ranging from pharmacy fraud health care-related money laundering. In
one case, four individuals were charged for their alleged roles in
establishing and operating four supposed healthcare clinics in Tampa,
Fl. – Palmetto General Health Care Inc., United Healthcare Center
Inc., New Imaging Center Inc. and Lord Physical Rehabilitation Center
Inc. – which they allegedly used to steal more than $2.5 million from
Medicare for surgical procedures that were never performed. The
defendants allegedly billed Medicare for surgical procedures used to
treat patients with high blood pressure by collapsing veins in the
legs, but they did not actually perform the procedures.
In Chicago, seven individuals were charged, including two doctors,
with a variety of health care fraud schemes.
In Brooklyn, N.Y., four individuals, including two doctors, were
charged in fraud schemes involving $9.1 million in false claims. In
one case, three additional individuals were allegedly involved in what
is now alleged to be a $15 million scheme where massages by unlicensed
therapists were billed to Medicare as physical therapy. Six
defendants were previously charged in the scheme.
The cases announced today are being prosecuted and investigated by
Medicare Fraud Strike Force teams comprised of attorneys from the
Fraud Section of the Justice Department’s Criminal Division and from
the U.S. Attorney’s Offices for the Southern District of Florida, the
Eastern District of Michigan, the Eastern District of New York, the
Southern District of Texas, the Central District of California, the
Middle District of Louisiana; the Northern District of Illinois, and
the Middle District of Florida; and agents from the FBI, HHS-OIG and
state Medicaid Fraud Control Units.
An indictment is merely a charge and defendants are presumed innocent
until proven guilty.
To learn more about HEAT, go to: www.stopmedicarefraud.gov.

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Last revised: May 14, 2013






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