June 4

Medicare Fraud: DOJ Charges 301 Individuals Involved in $900M False Billings

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DOJ Attorney General Lynch Medicare FraudDOJ Attorney General Lynch Medicare Fraud

The Department of Justice (DOJ) arrested and filed criminal and civil charges against 301 individuals including 61 doctors, nurses, and other licensed professionals involved in Medicare fraud.

According to Attorney General Loretta E. Lynch and Secretary Mathers Burwell of the Department of the Health and Human Services (HHS), those individuals were caught by the Medicare Fraud Strike Force in 36 federal districts. Twenty-three Medicaid Fraud Control Units also participated in the arrests.

Largest takedown

It is the “largest takedown” in history, against individuals defrauding the Medicare and other federal insurance programs. The defendants allegedly participated in healthcare fraud schemes involving approximately $900 million in false billings.

The defendants were charged with 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 DOJ based the charges on various fraud allegations involving different medical treatments and services such as home healthcare, psychotherapy, physical and occupational therapy, durable medical equipment (DME) and prescription drugs.

Medicare Part D

More than 60 of the defendants are facing lawsuits for allegedly defrauding the Medicare prescription drug benefit program known as Part D— the fastest-growing component of the Medicare program.

In a statement, Attorney General Lynch said, “As this takedown should make clear, healthcare fraud is not an abstract violation or benign offense – It is a serious crime,”

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“The wrongdoers that we pursue in these operations seek to use public funds for private enrichment.  They target real people – many of them in need of significant medical care.  They promise effective cures and therapies, but they provide none.  Above all, they abuse basic bonds of trust – between doctor and patient; between pharmacist and doctor; between taxpayer and government – and pervert them to their own ends,” added the Attorney General.

CMS to suspend payment to a number of providers

The HHS Centers for Medicare & Medicaid Services (CMS) is using its authority under the Affordable Care Act to suspend payments to a number of providers.

According to Secretary Burwell, the HHS will continue to put new tools and additional resources including the $350 million from the Affordable Care Act, to prevent healthcare fraud.

“Millions of seniors depend on Medicare for essential health coverage, and our action shows that this administration remains committed to cracking down on individuals who try to defraud the program,” said Secretary Burwell.

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