On May 2, the U.S. Department of Justice (DOJ) and Department of Health and Human Services (HHS) announced a nationwide takedown by Medicare Fraud Strike Force operations resulting in charges against 107 individuals, including doctors, nurses and other licensed medical professionals, for their alleged participation in Medicare fraud schemes. The schemes allegedly involve approximately $452 million in false billing, the highest amount of false Medicare billings in a single takedown in strike force history.
The defendants are charged with various healthcare fraud-related crimes, including conspiracy to commit healthcare fraud, healthcare fraud, violations of the anti-kickback statutes and money laundering. The accused allegedly participated in schemes to submit claims to Medicare for treatments that were medically unnecessary and oftentimes never provided. The DOJ notes, "[i]n many cases ... 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." The charges involve a variety of medical services, including home healthcare, mental health, psychotherapy, physical and occupational therapy, durable medical equipment and ambulance services across seven cities, including, Miami, Baton Rouge, Houston, Los Angeles, Detroit, Tampa and Chicago.
In addition to the indictments, HHS suspended payment or took other administrative actions against 52 providers following a data-driven analysis and credible allegations of fraud. PPACA significantly increased HHS's ability to suspend payments until an investigation is complete, and the announcement on May 2 shows that HHS is not shy about flexing its new muscles. The arrests and payment holds are intended to "send a strong message to criminals that the consequences of committing Medicare fraud are serious...[and] are another example of how the Affordable Care Act is helping the Obama Administration fight fraud and strengthen the Medicare program." The takedown involved the participation of more than 500 law enforcement agents from the FBI, HHS Office of Inspector General, multiple Medicaid Fraud Control Units and other state and local law enforcement agencies.