September 13, 2011

HEAT Charges 91 in $295 Million Fraud Schemes

By

k-longDoctors, nurses and health care company owners were among the 91 people in eight cities charged in the largest single-takedown amount in the history of the Health Care Fraud Enforcement and Prevention Action Team (HEAT).

About 400 law enforcement officers from agencies including the FBI and HHS Office of Inspector General participated in the 91 arrests, which occurred over two weeks, HHS stated.

The schemes, which totaled $295 million in fraudulent billing, included home health, physical and occupational therapy, mental health services, psychotherapy and durable medical equipment, HHS stated.

"In many cases, indictments and complaints allege that patient recruiters, Medicare beneficiaries and other co-conspirators were paid cash kickbacks in return for supplying beneficiary information to providers so that the providers could submit fraudulent billing to Medicare for services that were medically unnecessary or never provided," HHS stated.

HHS explained the arrests:

  • Miami - 46 arrests. Some of the arrests included mental health services in which "beneficiaries who were residents of halfway houses were allegedly threatened with eviction if they did not agree to attend the mental health center."
  • Houston - two arrests that accounted for $62 million in false claims for home health and DME. "One defendant allegedly sold beneficiary information to 100 different Houston-area home health care agencies in exchange for illegal payments."
  • Baton Rouge, La. - 10 arrests related to false claims for home health and DME. One indictment includes a doctor, nurse and five co-conspirators that allegedly billed Medicare for more than $19 million for medically unnecessary or not provided home health and skilled nursing services.
  • Detroit - 18 arrests including 14 defendants that allegedly billed $14 million in false claims as part of a home health scheme.
  • Los Angeles - six arrests.
  • Brooklyn - three arrests.
  • Dallas - two arrests.
  • Chicago - four arrests.

About the Author

Karen Long is the compliance product manager for DecisionHealth and oversees products that relate to fraud and abuse and HIPAA compliance for physician offices and home health agencies, and accreditation compliance for hospitals. In her almost four years at DecisionHealth, Karen also has been the compliance editor and a reporter for Home Health Line, nation's leading independent authority on home healthcare business, regulation and reimbursement.

Contact the Author

KLong@decisionhealth.com

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For more on the charges, read the HHS press release, please click here.

Karen Long

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