Medicare books 91 fraud indictments at a price tag of $295M

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A nationwide takedown by Medicare Fraud Strike Force operations in eight cities has resulted in charges against 91 defendants, including doctors, nurses and other medical professionals, for their alleged participation in Medicare fraud schemes involving approximately $295 million in false billing.

The U.S. Departments of Justice and Health and Human Services' (HHS) Medicare Fraud Strike Force is a multi-agency team of federal, state and local investigators that combat Medicare fraud through the use of Medicare data analysis techniques and an increased focus on community policing. Over the course of the past week, approximately 400 law enforcement agents from the FBI, HHS-Office of Inspector General (HHS-OIG), multiple Medicaid Fraud Control Units, and other state and local law enforcement agencies participated in the takedown. In addition to making arrests, agents also executed 18 search warrants in connection with ongoing strike force investigations.

The defendants are accused of various healthcare fraud-related crimes, including conspiracy to defraud the Medicare program, healthcare 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 such as home healthcare, physical and occupational therapy, mental health services, psychotherapy and durable medical equipment (DME).

In Miami, 45 defendants, including one doctor and one nurse, were charged for their participation in various fraud schemes involving $159 million in false bills for home healthcare, mental health services, occupational and physical therapy, DME and HIV infusion. Another defendant in Miami was charged for a $1 million Medicare fraud scheme.

In Houston, two individuals were charged with fraud schemes involving $62 million in false bills for home healthcare and DME. According to an indictment, one defendant allegedly sold beneficiary information to 100 different Houston-area home healthcare agencies in exchange for illegal payments. The indictment alleges that the home agencies then used the beneficiary information to bill Medicare for services that were unnecessary or never provided.

Ten defendants were charged in Baton Rouge, La., for participating in schemes involving more than $24 million related to false claims for home healthcare and DME.

Six defendants, including two doctors, were charged in Los Angeles for their roles in schemes to defraud Medicare of more than $10.7 million. In Brooklyn, N.Y., three defendants, including two doctors, were charged for a fraud scheme involving more than $3.4 million in false claims for medically unnecessary physical therapy. Two defendants, including a doctor, are making initial appearances in U.S. federal court in Dallas after being charged for a scheme to defraud Medicare of approximately $2.1 million.

In Detroit, 18 defendants, including three doctors, were charged last week for schemes to defraud Medicare of more than $28 million. Finally, four defendants, including one doctor, were charged in Chicago for their alleged roles in schemes to defraud Medicare of more than $4.4 million.

An indictment is a charge and defendants are presumed innocent until proven guilty, added the HHS.