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HHS, FBI, CMS join together for national Medicare fraud takedown

The Medicare Fraud Strike Force brought charges against 243 individuals across 17 districts, including 46 health care providers, nurses and others, for their supposed involvement in Medicare fraud schemes, which resulted in nearly $712 million in false billings, according to a press release from the HHS.

“This action represents the largest criminal health care fraud takedown in the history of the Department of Justice, and it adds to an already remarkable record of enforcement. The defendants charged include doctors, patient recruiters, home health care providers, pharmacy owners and others. They billed for equipment that wasn’t provided, for care that wasn’t needed, and for services that weren’t rendered. In the days ahead, the department of justice will continue our focus on preventing wrongdoing and prosecuting those whose criminal activity drives up medical costs and jeopardizes a system that our citizens trust with their lives. We are prepared — and I am personally determined — to continue working with our federal, state, and local partners to bring about the vital progress that all Americans deserve,” Attorney General Loretta E. Lynch said in the release.

The charges brought against the defendants are based on various fraud plans that included home health care, psychotherapy, physical and occupational therapy, durable medical equipment and pharmacy fraud. Charges included conspiracy to commit health care fraud, violations of the anti-kickback statues, money laundering, aggravated identity theft, and various other health care fraud-related crimes. Additionally, over 44 individuals face charges associated with Medicare Part D.

Many of the alleged fraud cases involved cash kickbacks to patient recruiters, beneficiaries or co-conspirators for Medicare and Medicaid claims for treatments that were either unnecessary or never provided.

The takedown, which involves claims in Florida, Texas, California, Michigan, New York and Louisiana, is the Medicare Fraud Strike Force’s largest takedown in both loss amount and number of defendants.

The fraud taskforce is part of the Health Care Fraud Prevention and Enforcement Action Team, which works to prevent fraud and enforce anti-fraud laws in the U.S.

Sylvia M. Burwell

HHS Secretary, Sylvia M. Burwell, said that takedowns like these are possible because of the new tools and resources the ACA has provided to help fight health care fraud. The ACA has provided an extra $350 million for the law, and improves screenings for providers and supplies, enhances enrollment requirements and encourages data sharing across government, according to the press release. In addition, it updated sentencing policies, which are now based on the amount billed to Medicare and would increase the amount of time criminals spend in prison for health care fraud.  

“Health care fraud drives up health care costs, wastes taxpayer money, undermines the Medicare and Medicaid programs, and endangers program beneficiaries. This record-setting takedown sends a message to would-be perpetrators that health care fraud is a risky way to line your pockets. Our agents and our law enforcement partners stand ready to protect these vital programs and ensure that those who would steal from federal health care programs ultimately pay for their crimes,” Inspector General Daniel R. Levinson of the HHS Office of Inspector General, said in the release.