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$430 Million in Fraudulent Medicare Billing

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Ninety-one doctors, nurses and other licensed medical professionals have been charged for alleged participation in Medicare fraud resulting in $430 million in false claims.

The government has charged 91 doctors, nurses and other licensed medical professionals for alleged participation in Medicare fraud schemes involving $429.2 million in false billing.

“Today’s takedown underscores the fact that federal efforts to combat health-care fraud have never been more strategic, more comprehensive, or more effective,” Attorney General Eric Holder at the conference said today at a news conference in Washington.

According to the Department of Justice (DOJ), the charges are based on a variety of alleged fraud schemes involving various medical treatments and services such as home health care, mental health services, psychotherapy, physical and occupational therapy, durable medical equipment and ambulance services.

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“From Brooklyn, to Miami, to Los Angeles, these defendants allegedly submitted approximately $430 million in fraudulent claims to the Medicare program,” Assistant Attorney General Lanny A. Breuer said at a press conference. “This represents one of the largest Medicare fraud takedowns in department history, as measured by the amount of alleged fraudulent billings.”

The indictments charge more than $230 million in home health care fraud, $100 million in mental health fraud, $49 million in ambulance transportation fraud and millions more in other frauds.

According to Breuer, in addition to charging the defendants with crimes, DOJ is also restraining the individuals’ assets.

According to the DOJ, the defendants allegedly participated in schemes to submit claims to Medicare for treatments that were medically unnecessary and oftentimes never provided. Miami was the biggest site of fraud with a total of 33 defendants involved in $204.5 million in false billings.

In Los Angeles, 16 individuals were charged with $53.8 million in false billings; 14 in Dallas were charged with $103.3 million in false billings; seven in Houston were charged with $158 million in false billings; 15 in Brooklyn were charged with $23.2 million in false billings; four in Baton Rouge were charged with $2.4 million in false claims; and two in Chicago were charged for millions of dollars in false claims.

“Such activities not only siphon precious taxpayer resources, drive up health care costs, and jeopardize the strength of the Medicare program — they also disproportionately victimize the most vulnerable members of society, including elderly, disabled, and impoverished Americans,” Holder said. “And, unfortunately, we allege that many of those charged today not only broke the law — but also violated their professional obligations, and sacred oaths, as medical practitioners.”

Read more:

Medicaid Audits Cost Far More than Discovered Fraud


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