Compliance officers in the healthcare industry take note: a nationwide takedown by the Medicare Fraud Strike Force has resulted in charges against a record 107 healthcare professionals for their alleged participation in Medicare fraud schemes that collectively resulted in approximately $452 million in fraudulent billing--the highest amount of false Medicare billings in a single takedown in the strike force's five-year history.
More than 500 law enforcement agents from the FBI, HHS-Office of Inspector General (HHS-OIG), multiple Medicaid Fraud Control Units, and other state and local law enforcement agencies participated in the crackdown announced jointly by Attorney General Eric Holder and Health and Human Services Secretary Kathleen Sebelius on May 2.
The Medicare Fraud Strike Force operations are part of the Health Care Fraud Prevention & Enforcement Action Team (HEAT), a joint initiative announced in May 2009 between the Department of Justice and HHS to focus their efforts to prevent and deter Medicare fraud and enforce current anti-fraud laws around the country. Since their inception in March 2007, strike force operations in nine locations have charged more than 1,330 defendants who collectively have falsely billed the Medicare program for more than $4 billion.
The HHS Centers for Medicare and Medicaid Services, working in conjunction with the HHS-OIG, also are taking steps to increase accountability and decrease the presence of fraudulent providers.
In addition to the 107 arrests, agents executed 20 search warrants in connection with ongoing strike force investigations. HHS also took other administrative actions against 52 healthcare providers suspected of fraud.
The accusations stem from violations of healthcare fraud, anti-kickback statutes, and money laundering. The charges are based on a variety of alleged fraud schemes involving various medical treatments and services such as home healthcare, mental health services, psychotherapy, physical and occupational therapy, durable medical equipment, and ambulance services.
According to court documents, the defendants allegedly participated in schemes to submit claims to Medicare for treatments that were medically unnecessary and often times 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 services that were medically unnecessary or never provided.
The cases are being prosecuted and investigated by Medicare Fraud Strike Force teams comprised of attorneys from the Fraud Section of the Justice Department's Criminal Division and from the U.S. Attorneys' Offices in seven states: the Southern District of Florida, the Eastern District of Michigan, the Southern District of Texas, the Central District of California, the Middle District of Louisiana, the Northern District of Illinois, and the Middle District of Florida.