DoJ charges 94 with alleged Medicare fraud, equaling $251M

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The Department of Justice (DoJ) has reported that 94 people, including some doctors and healthcare company owners, have been charged for their alleged participation in schemes to collectively submit more than $251 million in false claims to the Medicare program in the continuing operation of the Medicare Fraud Strike Force across the U.S.

The joint DoJ-Department of Health and Human Services (HHS) Medicare Fraud Strike Force is a team of federal, state and local investigators charged with combating Medicare fraud through the use of Medicare data analysis techniques and an increased focus on community policing.

Charges were brought against 94 individuals who are accused of various Medicare fraud-related offenses, including conspiracy to defraud the Medicare program, criminal false claims, violations of the anti-kickback statutes and money laundering, according to DoJ. The charges are based on a variety of fraud schemes, including physical therapy and occupational therapy schemes, home healthcare schemes, HIV infusion fraud schemes and durable medical equipment (DME) schemes.

Those accused of Medicare fraud are:

  • In Miami, 24 defendants were charged for allegedly participating in various fraud schemes that led to approximately $103 million in false billings. According to court documents, the fraud schemes involved fraudulent billing for HIV infusion services, home healthcare and physical therapy services, DME and pharmaceutical medications.
  • Thirty-one defendants were charged in Baton Rouge, La., for various schemes allegedly involving fraudulent claims for DME totaling approximately $32 million. The defendants include the owners and operators of nine different purported medical services companies and four doctors, 14 patient recruiters and other individuals who allegedly worked at the medical services companies.
  • Twenty-two defendants were charged in Brooklyn, N.Y., for alleged participation in schemes to submit fraudulent claims totaling approximately $78 million. These fraud schemes involved false billing for physical and occupational therapy and DME. The defendants include the owners and operators, patient recruiters and employees at three purported medical clinics and a medical equipment company, as well as three doctors. According to court documents, six of the defendants charged are serial Medicare beneficiaries, who purported to seek medical treatment from numerous providers, causing the submission of claims to Medicare for purported medical treatments.
  • In Detroit, 11 defendants were charged for their alleged roles in schemes to submit fraudulent claims to Medicare for home health services, nerve conduction tests and injection and infusion therapy sessions. The schemes involved a total alleged fraud of approximately $35 million and five different purported medical services companies.
  • Four defendants were also charged in Houston for their alleged roles in a $3 million scheme to submit fraudulent claims for DME.

In addition to making arrests around the U.S., law enforcement agents are executing search warrants in connection with ongoing healthcare fraud investigations, DoJ added.