Health Care Fraud Takedown: 111 Charged Nationwide

Twenty individuals, including three doctors, were charged in South Florida earlier this week for their alleged participation in a fraud scheme involving $200 million in Medicare billing for mental health services.

And that was just a precursor to today’s national federal health care fraud takedown involving charges against 111 defendants in nine cities in connection with their alleged participation in schemes to bilk Medicare out of an additional $225 million. More than 700 law enforcement personnel from the FBI and Health and Human Services-Office of Inspector General (HHS-OIG), multiple Medicaid fraud control units, and other state and local law enforcement agencies took part in today’s operation, which was announced at a press conference in Washington, D.C.

HEAT. The Florida case and the cases involved in today’s takedown were the result of the Department of Justice/HHS Health Care Fraud Prevention and Enforcement Action Team, or HEAT, initiative and its Medicare Fraud Strike Force operating in a number of U.S. cities. In addition to Baton Rouge, Brooklyn, Detroit, Houston, Los Angeles, Miami, and Tampa, Attorney General Eric Holder announced at today’s press conference the expansion of the strike force into two more cities—Chicago and Dallas.

Medicare Strike Force members include federal, state, and local investigators who use data analysis techniques to identify high-billing levels in health care fraud hot spots, targeting chronic fraud and emerging or migrating schemes by criminals masquerading as health care providers or suppliers.

In the Florida case, the indictment alleges that various defendants paid kickbacks to patient brokers and owners or operators of halfway houses and assisted living facilities for delivering patients to community mental health facilities owned by a particular corporation. The facilities would then submit claims to Medicare for services that weren’t medically necessary, or weren’t provided at all. 

The defendants charged in today’s takedown are accused of various fraud-related crimes, including conspiracy to defraud Medicare, criminal false claims, violations of the anti-kickback statutes, money laundering, and aggravated identify theft. Some of the cases include:

■Nine charged in Houston for $8 million in fraudulent Medicare claims for physical therapy, durable medical equipment, home health care, and chiropractor services.

■Five charged in Los Angeles for a scheme to defraud Medicare of more than $28 million by submitting false claims for durable medical equipment and home health care.

■11 charged in Chicago for conspiracies to defraud Medicare of $6 million related to false billing for home health care, diagnostic testing, and prescription drugs.

In addition to our involvement with HEAT and the Medicare Fraud Strike Force, the FBI remains committed to working additional health care fraud investigations with our partners at HHS-OIG, individual state Medicare fraud offices, and investigative units from major private insurance companies. We also work jointly with the Drug Enforcement Administration, the Food and Drug Administration, and the Department of Homeland Security to address drug diversion, Internet pharmacies, prescription drug abuse, and other health care fraud threats.

We’re currently working more than 2,600 pending health care fraud investigations. During fiscal year 2010, cooperative efforts with our law enforcement partners led to charges against approximately 930 individuals and convictions of almost 750 subjects. But perhaps even more satisfying—we dismantled dozens of criminal enterprises engaged in widespread health care fraud.

This article was sponsored by Police Books.