Federal task force bust alleges more than $400 million in Medicare fraud

October 5, 2012

Several physicians were among the 91 people recently charged by a Medicare fraud task force for alledgedly making roughly $430 million in false billing claims.

Nearly 100 individuals-including some physicians-were charged by the Medicare Fraud Strike Task Force this week for fraud schemes resulting in nearly $430 million in false billing.

The Medicare Fraud Strike Force, a joint effort involving more than 500 agents from the U.S. Justice Department and the Department of Health and Human Services (HHS), levied charges in seven states against a variety of licensed medical professionals, including doctors and nurses. The charges include more than $230 million in home healthcare fraud, more than $100 million in mental healthcare fraud, and more than $49 million in ambulance transportation fraud, according to the task force.

“Today’s enforcement actions reveal an alarming and unacceptable trend of individuals attempting to exploit federal healthcare programs to steal billions in taxpayer dollars for personal gain,” U.S. Attorney General Eric Holder says. “Such activities not only siphon precious taxpayer resources, drive up healthcare 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.”

HHS says defendants allegedly participated in schemes to submit claims to Medicare for treatments that were medically unnecessary or never provided. In many cases, court documents allege that patient recruiters, Medicare beneficiaries, and other co-conspirators were paid cash kickbacks in return for supplying beneficiary information to providers, so that the providers could submit fraudulent billing to Medicare for the services, HHS reports.

Three doctors were among those charged in California for allegedly participating in various fraud schemes involving a total of $53.8 million in false billings. In Texas, two doctors and two registered nurses were among those charged for their alleged roles in making more than $103 million in false billings for home healthcare services. HHS says one physician alone signed approximately 33,000 prescriptions for more than 2,000 unique Medicare beneficiaries from 2006 to 2011. Many of them had primary care physicians who never certified home healthcare services for them. To handle the volume of prescriptions, the doctor allegedly signed stacks of documents without reviewing them, according to HHS.

“Today’s arrests put criminals on notice that we are cracking down hard on people who want to steal from Medicare,” HHS Secretary Kathleen Sebelius says. “The healthcare law gives us new tools to better fight fraud and make Medicare stronger."

In addition to the charges levied against the 91 individuals, HHS also has called on new authority derived from the Affordable Care Act to stop future payments to at least 30 healthcare providers suspected of fraud based on “credible allegations.”

Go back to current issue of eConsult.