Justice Dept arrests over 300 health professionals for $1 Billion in Medicare fraud

The U.S. Justice Department has arrested hundreds of professional medical personnel for allegedly billing nearly $1 billion for unnecessary and false medical treatments under Medicare and Medicaid plans. The DOJ said in a press release that the  Medicare Fraud Strike Force, working across 36 federal jurisdictions, arrested 301 individuals, including 61 doctors, nurses and other licensed medical professionals for their alleged participation in healthcare fraud related crimes totaling approximately $900 million in false and unnecessary treatment, prescriptions, and medical healthcare services.According to documents filed by the Department of Justice (DOJ), the medical personnel are being charged with a variety of healthcare fraud related crimes including conspiracy to commit healthcare fraud, violations of the kick-back statutes, money laundering, and aggravated identity theft.

Officials claim a large portion of the fraudulent billings came from various medical treatments and services, such as home healthcare, psychotherapy, physical and occupational therapy, durable medical equipment and prescription drugs. At least 60 of the individuals charged this week are alleged to have issued false prescriptions under the Medicare prescription drug benefit program known as Medicare Part D.

Dozens of charges for conspiracy to commit healthcare fraud stem from patient recruiters, Medicare beneficiaries, and other co-conspirators being paid kick-backs in return for supplying beneficiary information to providers, so that providers could submit fraudulent bills to Medicare for unnecessary and unjustifiable services.

The DOJ found 10 persons in the Eastern District of New York who had allegedly filed more than $86 million in fraudulent physical and occupational therapy claims to Medicare and Medicaid. The defendants are alleged to have compiled a network of Brooklyn clinics that they controlled by paying bribes and kickbacks and in return the patients would be subject to unnecessary therapy to accumulate further medical costs. The defendants are alleged to have laundered the proceeds from this fraudulent billing through over a dozen shell companies to avoid suspicion.

In the Southern District of Florida, 100 defendants were charged with various home healthcare, mental health services, and pharmacy fraud amounting upward of $220 million.
The agency pinpointed at least nine defendants that owned and operated six different home health care services that the DOJ claims were solely for the purpose of billing Medicare services that were not necessary. The defendants are alleged to have falsely billed at least $24 million from the scheme.

Including this week’s charges, nearly 1,200 individuals have been charged with fraudulent medical practices as part of the nationwide take-down operation. To date more than $3.4 billion in fraudulent billings are being investigated.

Jeffrey Newman represents whistleblowers