The miserable state of the nation? And this is just the proverbial tip of one massively gigantic iceburg.
Medicare sting nets $295 million in fraud charges
Wednesday September 7, 2011
Collectively, the physicians, nurses, medical professionals, healthcare company owners and others charged in the indictments and complaints are accused of conspiring to submit a total of approximately $295 million in fraudulent billing.
In Miami, 45 defendants, including one doctor and one nurse, were charged for their participation in various fraud schemes involving a total of $159 million in false billings for home healthcare, mental health services, occupational and physical therapy, DME and HIV infusion.
In one of the Miami cases, 24 defendants are charged for participating in a community mental health center fraud scheme involving more than $50 million in fraudulent billing. According to court documents, the defendants allegedly paid patient recruiters to refer ineligible beneficiaries to the mental health center. In some instances, beneficiaries who were residents of halfway houses were allegedly threatened with eviction if they did not agree to attend the mental health center.
In Houston, two individuals were charged with fraud schemes involving $62 million in false billings for home healthcare and durable medical equipment. 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. According to one indictment, a doctor, nurse and five other co-conspirators participated in a scheme to bill Medicare for more than $19 million in skilled nursing and other home health services that were medically unnecessary or never provided.
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, 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, made initial appearances Wednesday 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. According to an indictment, 14 of the defendants participated in a home healthcare scheme that submitted more than $14 million in false claims to Medicare.
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.
“As charged in these indictments, the defendants cover nearly the entire spectrum of healthcare providers, and perpetrated a variety of fraudulent schemes,” Assistant Attorney General Lanny A. Breuer said at the news conference. “From Brooklyn to Miami to Los Angeles, the defendants allegedly treated the Medicare program like a personal piggy bank. Today’s Strike Force operations should serve as a wake-up call to would-be fraudsters nationwide.”
The joint Department of Justice-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. During the past week, approximately 400 law enforcement agents from the FBI, HHS-Office of Inspector General, multiple Medicaid Fraud Control Units and other state and local law enforcement agencies participated in the takedown.
Just another day in paradise . . .