Medicare fraud: Feds charge 90-plus people for $260 million in false claims

Six US cities, including Miami, were featured in the crackdown. With the continued ramping up of Obamacare, enforcement of laws that prevent Medicare and other health-care fraud will become increasingly important.

AP
Wifredo Ferrer, (l.), U.S. Attorney for the Southern District of Florida, speaks during a news conference along with George Piro, (c.), Special Agent in Charge for the Federal Bureau of Investigation Miami and Tyler Smith, Assistant Inspector General of the U.S. Department of Health and Human Services, Office of Inspector General, Tuesday, in Miami. Officials said that the latest Medicare fraud sweep has netted 90 arrests in six cities involving false billings to the health care program of an estimated $260 million.

More than 90 individuals were charged on Tuesday in a nationwide crackdown against what investigators said was massive fraud in federally administered health-care programs.

The defendants were charged with submitting more than $260 million in fraudulent claims to the Medicare system. They included 27 medical professionals, including 16 physicians, who prosecutors say breached the public trust in pursuit of easy money.

The arrests took place in Miami; Tampa, Fla.; New York; Detroit; Houston; and Los Angeles.

“The fraud was rampant, it was brazen, and it permeated every part of the Medicare system,” Acting Assistant Attorney General David O’Neil said in announcing the enforcement operation.

“The crimes charged represent the face of health care fraud today – doctors billing for services that were never rendered, supply companies providing motorized wheelchairs that were never needed, recruiters paying kickbacks to get Medicare billing numbers of patients,” Mr. O’Neil said in a statement.

The investigation was undertaken by the Justice Department’s Medicare Strike Force, which since organizing in 2007 has charged 1,900 defendants in cases involving $6 billion in medical services fraud.

The enforcement action was praised by both Attorney General Eric Holder and Health and Human Services Secretary Kathleen Sebelius.

Mr. Holder called the operation “another important step forward in our ongoing fight to safeguard taxpayer resources and to ensure the integrity of essential health care programs.”

Secretary Sebelius noted that the Affordable Care Act, the health-care reform law, grants federal agents greater authority to suspend Medicare payments when fraud is suspected.

“Today we’re sending a strong, clear message to anyone seeking to defraud Medicare: You will get caught and you will pay the price,” she said.

Health-care fraud has long been perceived among criminals as low-hanging fruit offering millions of dollars in illicit profits with little chance of being caught. With the continued ramping up of Obamacare and the influx of ever-greater amounts of federal money into the health-care system, strict enforcement will become increasingly important.

Among the six cities featured in the crackdown, Miami had, by far, the largest group of defendants. Federal agents charged 50 individuals on Monday and Tuesday for their alleged involvement in false billings totaling $65 million.

In one $23 million scheme in south Florida, two defendants allegedly obtained Medicare beneficiary information from a pharmacy owner and used the information to bill the government for drugs that were never dispensed. Kickbacks were laundered through shell companies to conceal the arrangement, prosecutors said.

In Houston, five local physicians are among 11 being prosecuted. The doctors were charged with conspiring to bill Medicare for home health services that were unnecessary and sometimes never provided, according to the government.

Eight individuals were charged in Los Angeles in connection with $32 million in fraudulent billings. The largest fraud was allegedly undertaken by a doctor who submitted $24 million in false claims, including for 1,000 motorized wheelchairs.

The seven charged in Detroit allegedly submitted $30 million in false claims involving home health care, psychotherapy, and infusion therapy, according to the Justice Department.

In Tampa, seven were charged with billing for services and tests that were never provided. In one $12 million scheme, the defendants allegedly used information of Medicare beneficiaries in Miami-Dade County to bill for services allegedly rendered in Tampa – 280 miles northwest of Miami.

In Brooklyn, federal prosecutors indicted a local surgeon for billing the government $85 million for surgeries that never took place. Also in Brooklyn, six others – including a physician – were charged with submitting $14.4 million for medically unnecessary vitamin infusions, diagnostic tests, and physical and occupational therapy.

In addition to charging the alleged fraudsters, federal agents have also sought to locate and seize illicit assets, including bank accounts, jewelry, and expensive cars.

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