Skip to main content

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

 |  By John Commins  
   September 08, 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.

In Houston, two people were charged with fraud schemes involving $62 million in false billings for home health care and DME. One defendant allegedly sold beneficiary information to 100 different Houston-area home healthcare agencies in exchange for illegal payments. The indictment alleges that the home agencies then used the beneficiary information to bill Medicare for services that were unnecessary or never provided.

In Baton Rouge, LA, 10 people were charged in schemes involving more than $24 million related to false claims for home healthcare and DME. According to one indictment, a doctor, a nurse and five other co-conspirators schemed to bill Medicare for more than $19 million in skilled nursing and other home health services that were medically unnecessary or never provided.

In Detroit, 18 people, including three doctors, were charged last week for schemes to defraud Medicare of more than $28 million. According to an indictment, 14 of the defendants participated in a home healthcare scheme that submitted more than $14 million in false claims to Medicare.

In Brooklyn, three people, including two doctors, were charged for a fraud scheme involving more than $3.4 million in false claims for medically unnecessary physical therapy. 

In Dallas, two people, including a doctor, were charged in a scheme to defraud Medicare of approximately $2.1 million, DOJ said.

 In Chicago, four people, including a doctor were charged for their alleged roles in schemes to defraud Medicare of more than $4.4 million.

In Los Angeles, six people, including two doctors, were charged in a scheme to defraud Medicare of more than $10.7 million.

Since its inception in March 2007, Strike Force operations in nine cities have charged more than 1,140 people who collectively have falsely billed the Medicare program for more than $2.9 billion.

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

Tagged Under:


Get the latest on healthcare leadership in your inbox.