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Feds Bust 90 Linked to Medicare Fraud Schemes Totaling $260M

 |  By John Commins  
   May 14, 2014

As the result of a multi-city operation, the Medicare Fraud Strike Force has brought charges against scores of people, including doctors, nurses, and other medical professionals allegedly involved in false billing schemes.

Federal prosecutors on Tuesday unveiled charges against 90 people in six cities for their alleged roles in Medicare frauds that resulted in $260 million in false billings.

The defendants include 16 physicians and 11 other people identified as "medical professionals," according to a joint media release from the Departments of Justice and Health and Human Services.

Acting Assistant Attorney General David A. O'Neil said in prepared remarks that the crimes identified in the investigation "represent the face of healthcare fraud today—doctors billing for services that were never rendered, supply companies providing motorized wheelchairs that were never needed, recruiters paying kickbacks to get Medicare billing numbers of patients."

"The fraud was rampant, it was brazen, and it permeated every part of the Medicare system. But law enforcement continues to strike back. Using cutting-edge, data-driven investigative techniques, we are bringing fraudsters to justice and saving the American taxpayers billions of dollars."

The investigations were led by the Medicare Fraud Strike Force in Los Angeles, Miami, Tampa, Houston, Brooklyn, and Detroit.

The defendants face charges including money laundering, conspiracy to commit healthcare fraud, and violations of anti-kickback statutes stemming from a number of schemes involving bogus medical treatments and services for home healthcare, mental health services, psychotherapy, physical and occupational therapy, durable medical equipment, and pharmacy fraud, federal officials said.

In Miami, 50 defendants were charged in various fraud schemes involving $65.5 million in false billings for home healthcare and mental health services, and pharmacy fraud. In one case, two defendants were charged in connection with a $23 million pharmacy kickback and laundering scheme.

In Houston, five physicians were among the 11 people charged with conspiring to bill Medicare for medically unnecessary home health services. The doctors allegedly were paid by co-conspirators to sign off on home healthcare services that were not necessary and often never provided.

In Los Angeles, eight defendants were charged in schemes to defraud Medicare of approximately $32 million. In one case, a doctor was charged for causing almost $24 million in losses to Medicare through his own fraudulent billing and referrals for durable medical equipment, including more than 1,000 expensive power wheelchairs, and home health services that were not medically necessary and frequently not provided.

In Detroit, seven defendants were charged for $30 million in false claims for medically unnecessary services, including home health services, psychotherapy, and infusion therapy. In one case, a physician and three other people were charged in a $28 million fraud scheme, where the physician billed for expensive tests, physical therapy and injections that were not necessary and not provided.

Court documents allege that when the physician's billings raised red flags, he was put on payment review by Medicare. He was allegedly able to evade detection by using the billing information of other Medicare providers, sometimes without their knowledge.

In Tampa, seven people were charged in schemes ranging from fraudulent physical therapy billings to a scheme involving millions of dollars in physician services and tests that never occurred. 

In one case, five individuals were charged for their alleged roles in a $12 million healthcare fraud and money laundering scheme that involved billing Medicare using names of beneficiaries from Miami-Dade County for services purportedly provided in Tampa clinics, 280 miles away.

In Brooklyn, Syed Imran Ahmed, MD, was indicted in connection with an alleged $85 million scheme involving billings for surgeries that never occurred. Six other people, including a physician and two billers were charged in an alleged $14.4 million scheme that billed Medicare for medically unnecessary vitamin infusions, diagnostic tests and physical and occupational therapy supposedly provided to patients who allegedly were recruited to take part in the scheme.

Since its inception in March 2007, Strike Force operations in nine locations have charged almost 1,900 defendants who collectively have falsely billed the Medicare program for almost $6 billion.

John Commins is a content specialist and online news editor for HealthLeaders, a Simplify Compliance brand.

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