The US Department of Health and Human Services (HHS) reports in a news release that a nationwide sweep led by the Medicare Fraud Strike Force in 17 districts resulted in charges against 243 individuals—including doctors, nurses, and other licensed medical professionals—for their alleged participation in Medicare fraud schemes involving approximately $712 million in false billings.

These individuals charged include those submitting fraudulent billing for physical therapy and occupational therapy services, and for durable medical equipment.

The release explains that HHS Secretary Sylvia M. Burwell, Attorney General Loretta E. Lynch, FBI Director James B. Comey, Assistant Attorney General Leslie R. Caldwell of the Justice Department’s Criminal Division, Inspector General Daniel R. Levinson of the HHS Office of Inspector General (HHS-OIG), and Deputy Administrator and Director of CMS Center for Program Integrity Shantanu Agrawal, MD, were present at the media announcement.

According to the release, the defendants are charged with various health care fraud-related crimes, including conspiracy to commit health care fraud, violations of the anti-kickback statutes, money laundering, and aggravated identity theft. The charges are based on a variety of alleged fraud schemes involving various medical treatments and services.

“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,” Lynch explains in the release.

Persons charged and fraudulent billings include the following, the release explains:

  • In Los Angeles, eight defendants were charged for their roles in schemes to defraud Medicare of approximately $66 million. In one case, a doctor is charged with causing almost $23 million in losses to Medicare through his own fraudulent billing and referrals for DME, including over 1,000 expensive power wheelchairs, and home health services that were not medically necessary and often not provided.
  • In Tampa, Florida, five individuals were charged with participating in a variety of schemes, ranging from fraudulent physical therapy billings to a scheme involving millions in physician services and tests that never occurred. In one case, a licensed pain management physician sought reimbursement for nerve conduction studies and other services that he allegedly never performed. Medicare paid the defendant over $1 million for these purported services.
  • In Brooklyn, NY, nine individuals were charged in two separate criminal schemes involving physical and occupational therapy. In one case, three individuals face charges for their roles in a previously charged $50 million physical therapy scheme. In the second case, six defendants were charged for their roles in a $8 million physical and occupational therapy scheme.

The release further explains that the announced cases are being prosecuted and investigated by Medicare Fraud Strike Force teams from the Fraud Section of the Justice Department’s Criminal Division and from the US Attorney’s Offices for the Southern District of Florida, Eastern District of Michigan, Eastern District of New York, Southern District of Texas, Central District of California, Eastern District of Louisiana, Northern District of Texas, Northern District of Illinois, and the Middle District of Florida; and agents from the FBI, HHS-OIG, and state Medicaid Fraud Control Units.

[Source: US Department of Health and Human Services]