The Medicare Strike Force on Thursday filed charges

By: Michael MacLaren |
Published: June 23, 2015
Author at Assurance Health Care Financial Services

The Medicare Strike Force on Thursday filed charges against 243 doctors, nurses, licensed medical professionals, health care company owners and others for allegedly submitted a total of $712 million in fraudulent billings, the result of a nationwide sweep that’s being called the largest healthcare fraud takedown history.

The Medicare Fraud Strike Force targeted fraud in 17 districts in the states of Florida, Texas, California, Louisiana, New York and Michigan.

In addition, the Centers for Medicare and Medicaid Services has suspended a number of providers, though none were individually named.

The charges involve various medical treatments and services, including home health care, psychotherapy, physical and occupational therapy, durable medical equipment and pharmacy fraud, officials said.

The defendants are charged with various health care fraud-related crimes, including conspiracy to commit health care fraud, violations of the anti-kickback statutes, money laundering and aggravated identity theft, according to the Justice Department.

More than 44 of the defendants are charged with fraud related to the prescription drug benefit program, Medicare Part D. Forty-six doctors, nurses and other licensed medical professionals are among those charged.

In Miami, a total of 73 defendants are charged with offenses involving approximately $263 million in false billings for home health care, mental health services and pharmacy fraud.
In one case, administrators in a mental health center billed close to $64 million and Medicare paid approximately half of the claimed amount.
In Houston and McAllen, Texas, 22 individuals are charged in cases involving over $38 million in alleged fraud. One company that paid the defendant for patient referrals submitted close to $16 million in claims, over $4 million of which was paid.

In Dallas, seven people are charged in connection with home health care schemes. In one, six owners and operators of a physician house call company submitted nearly $43 million in billings under the name of a single doctor, regardless of who actually provided the service.

In Los Angeles, eight defendants are charged in schemes to defraud Medicare of approximately $66 million. In one case, a doctor is charged with causing almost $23 million in losses to Medicare, including billing over 1,000 expensive power wheelchairs that were not medically necessary.

In Detroit, 16 defendants face charges for their alleged roles in fraud, kickback and money laundering schemes involving approximately $122 million in false claims for services that were medically unnecessary or never rendered, including home health care, physician visits, and psychotherapy, as well as pharmaceuticals that were billed but not dispensed.

In Tampa, five individuals are charged with participating in a variety of schemes, ranging from fraudulent physical therapy billings to a scheme involving millions in physician services and tests that never occurred. In one case, Medicare paid over $1 million to a licensed pain management physician who sought reimbursement for nerve conduction studies and other services he allegedly never performed.

In Brooklyn, New York, nine individuals are charged in two separate criminal schemes involving physical and occupational therapy, in which a total of $58 million was billed.
In New Orleans, 11 people are charged in connection with $110 million in home health care and psychotherapy schemes.

One case involved four individuals who operated two companies – one in Louisiana and one in California – that mass-marketed talking glucose monitors. The companies billed Medicare approximately $38 million for the devices and Medicare paid the companies over $22 million.