Doctors, Nurses, Others Charged in $452 Million in False Billing Schemes in Nationwide Takedown

Charges have been brought against 107 individuals, including doctors, nurses, and other licensed medical professionals, for their alleged participation in Medicare fraud schemes involving approximately $452 million in false billing, government officials announced yesterday.

 

Officials from the Office of Inspector General of the U.S. Department of Health and Human Services and the Department of Justice said the charges were the result of a nationwide takedown in seven cities by the Medicare Fraud Strike Force and said to involve the "highest amount" of false Medicare billings in a single takedown in the strike force's history.

HHS also suspended or took other administrative action against 52 providers following a data-driven analysis and credible allegations of fraud. The joint DOJ and HHS Medicare Fraud Strike Force, described by government as a multi-agency team of federal, state, and local investigators, involved more than 500 law enforcement agents from the FBI, the OIG, multiple Medicaid Fraud Control Units, and other state and local law enforcement agencies.

 

In addition to making arrests, agents also executed 20 search warrants in connection with ongoing strike force investigations.

 

The defendants charged are accused of various healthcare fraud-related crimes, including conspiracy to commit 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 health care, mental health services, psychotherapy, physical and occupational therapy, durable medical equipment (DME), and ambulance services, according to the OIG in a news release issued yesterday.

 

The OIG referred to court documents which said defendants allegedly participated in schemes to submit claims to Medicare for treatments that were medically unnecessary and often never provided. In many cases, according to the OIG, 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 the providers could submit fraudulent billing to Medicare for services that were medically unnecessary or never provided.

 

Collectively, the doctors, nurses, licensed medical professionals, healthcare company owners, and others charged are accused of conspiring to submit a total of approximately $452 million in fraudulent billing, the OIG said.

 

According to the OIG, charges were brought against the following:

 

  • In Miami, a total of 59 defendants, including three nurses and two therapists, were charged yesterday and Tuesday for their participation in various fraud schemes involving a total of $137 million in false billings for home health care, mental health services, occupational and physical therapy, DME, and HIV infusion, according to the OIG news release. Two of these 59 defendants were originally charged in April 2012 but were indicted on additional charges yesterday, the OIG stated. In one case, according to the OIG, 10 defendants were charged for participating in a fraud scheme at Health Care Solutions Network, which led to approximately $63 million in fraudulent billing for community mental health center (CMHC) services. The OIG said court documents allege that therapists at Health Care Solutions Network were instructed to alter notes and other medical documents to justify CMHC services for beneficiaries who did not need the services.
  • Seven individuals were charged yesterday in Baton Rouge, La., for participating in a fraud scheme involving $225 million in false claims for CMHC services. The case represents the largest CMHC-related scheme ever prosecuted by the Medicare Fraud Strike Force. The OIG said court documents showed the defendants recruited beneficiaries from nursing homes and homeless shelters, some of whom were drug addicted or mentally ill, and provided them with no services or medically inappropriate services.
  • In Houston, nine individuals, including one doctor and one nurse, were charged today with fraud schemes involving a total of $16.4 million in false billings for home health care and ambulance services. According to the OIG, court documents revealed that owners and operators of four different ambulance companies billed Medicare for ambulance rides that were medically unnecessary.
  • In Los Angeles, eight defendants, including two doctors, were charged for their roles in schemes to defraud Medicare of approximately $14 million. In one case, two individuals allegedly billed Medicare for more than $8 million in fraudulent charges for DME, said the OIG.
  • Twenty-two defendants in Detroit, including four licensed social workers, were charged with participating in fraud schemes involving approximately $58 million in false claims for medically unnecessary services, including home health, psychotherapy and infusion therapy.
  • In Tampa, Fla., a pharmacist was charged with illegal diversion of controlled substances.
  • One defendant was charged last week in Chicago for his alleged role in a scheme to submit approximately $1 million in false billing to Medicare for psychotherapy services.

 

Since its inception in March 2007, Strike Force operations in nine locations have resulted in charges against more than 1,330 defendants who collectively have falsely billed the Medicare program for more than $4 billion, according to the OIG, which also noted that an indictment is merely a charge and defendants are presumed innocent until proven guilty.

 

"We have brought back billions of dollars as a result of shutting down healthcare scams of all varieties" in all states across the county, said Inspector General Daniel Levinson during a special edition of Monitor Monday, broadcasting live during the Health Care Compliance Association's annual Compliance Institute on Monday. "We have a lot to show for our work."

 

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