Ninety individuals charged with fraud by Medicare Strike Force

Attorney General Eric Holder and former Department of Health and Human Services Secretary Kathleen Sebelius announced today that 90 individuals, including 27 doctors, nurses and health care professionals, have been charged for participation in Medicare fraud.

HHS alleges $260 million in false billings were discovered through Strike Force operations in six cities. Charges include conspiracy to commit healthcare fraud, money laundering and violations of anti-kickback statutes. The charges involved alleged schemes in various medical treatments.

According to a press release from HHS, the fraudulent activity included submitting bills for treatments that were unnecessary or never performed, and in some cases, Medicare recipients and others were paid cash rewards for participating in the fraudulent activity.

“Among the defendants charged were 27 medical professionals, including 16 doctors,” acting Assistant Attorney General, David A. O’Neil, said in the press release. “The crimes charged represent the face of health care fraud today – doctors billing for services that were never rendered, supply companies providing motorized wheelchairs that were never needed, recruiters paying kickbacks to get Medicare billing numbers of patients. The fraud was rampant, it was brazen, and it permeated every part of the Medicare system.”

Syed Imran Ahmed, MD, was the only individual named by the Brooklyn Strike Force in the release. Ahmed was indicted for allegedly billing $85 million for surgeries that never occurred.

Six other individuals were also charged with fraud, including “a physician and two billers who allegedly concocted a $14.4 million scheme in which they recruited elderly Medicare beneficiaries and billed Medicare for medically unnecessary vitamin infusions, diagnostic tests and physical and occupational therapy supposedly provided to these patients,” according to the release.

Seven individuals in Detroit were charged for allegedly filing $30 million in false billings for medically unnecessary treatments. Four individuals, including a doctor, were charged with billing for unnecessary tests, injections and physical therapy. The release said that court documents show that when one doctor’s billings “raised red flags” and was put on billing review, he allegedly continued a false billing scheme by using other providers, at times without their knowledge.

In Tampa, seven were charged in a $12 million scheme that involved billing for Medicare beneficiaries who lived 280 miles away and laundered the money using “shell entities,” according to the release.

“Today we’re sending a strong, clear message to anyone seeking to defraud Medicare: You will get caught and you will pay the price. We will protect a sacred trust and an earned guarantee,” Sebelius said in the release.

Kathleen Sebelius

According to Sebelius, provisions in the Affordable Care Act, also known as Obamacare, aided the operation.

“The Affordable Care Act has given us additional tools to preserve Medicare and protect the tens of millions of Americans who rely on it each day,” she said. “By expanding our authority to suspend Medicare payments and reimbursements when fraud is suspected, the law allows us to better preserve the system and save taxpayer dollars.”

The sting represents the seventh national fraud initiative since 2007. In that time, nearly 1,900 defendants have been charged with false billing totaling almost $6 billion, and 17,000 providers have been removed from the Medicare program.

“Medicare is a sacred compact with our nation’s seniors, and to protect it, we must remain aggressive in combating fraud,” Holder said in the press release. “This nationwide Medicare Strike Force takedown represents another important step forward in our ongoing fight to safeguard taxpayer resources and to ensure the integrity of essential health care programs. Department of Justice will not tolerate these activities, and we will continue working alongside the Department of Health and Human Services — as well as federal, state, and local partners — to use every appropriate tool and available resource to find, stop and punish those who seek to take advantage of their fellow citizens.”