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Feds Nab 91 Suspects in Medicare Billing Schemes Totaling $295M

John Commins, for HealthLeaders Media, September 8, 2011

Federal authorities on Wednesday detailed an eight-city sweep by the Medicare Fraud Strike Force that netted 91 suspects -- including 11 doctors and two nurses – for various fraud schemes involving false billing.

The value of the sweep represented the single highest amount of false Medicare billings in the four-year history of the Strike Force, which used more than 400 investigators from the Department of Justice, FBI, Health and Human Services -- Office of the Inspector General, and state and local law enforcement agencies for the raids, federal authorities said in a joint media release. 

“Today’s arrests are a powerful warning to those who would try to defraud taxpayers and Medicare beneficiaries,” HHS Secretary Kathleen Sebelius said. “These arrests illustrate close cooperation between the Medicare program that identified these fraudsters and the law enforcement officials who acted swiftly to cut them off.  And our efforts to stop criminals don’t end here because the Affordable Care Act gives us new tools to prevent Medicare fraud before it is committed – better protecting seniors and the integrity of the Medicare program for generations to come.”

Federal prosecutors detailed the allegations in each city:

 In Miami, 45 people, including a doctor and a nurse, were charged in various fraud schemes involving a total of $159 million in false billings for home healthcare, mental health services, occupational and physical therapy, DME and HIV infusion. In one case, 24 people are charged with participating in a community mental health center fraud scheme involving more than $50 million in fraudulent billing. The defendants allegedly paid patient recruiters to refer ineligible beneficiaries to the mental health center.  In some instances, beneficiaries who were residents of halfway houses were allegedly threatened with eviction if they did not attend the mental health center.

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