Largest Healthcare Fraud Takedown in Justice Department History

According to the Justice Department, the Medicare Fraud Strike Force conducted a nationwide operation in 17 cities this week. The sweep resulted in criminal charges against 243 individuals for their alleged participation in healthcare fraud schemes involving over $700 million in false billings to government healthcare programs. Forty-six (46) of the individuals were doctors, nurses, or other licensed medical professionals. According to the U.S. Attorney for the Southern District of Florida, seventy-three (73) of the individuals are residents of South Florida.

According to the U.S. Attorney General, those charged are alleged to have participated in various criminal activities including violation of the anti-kickback statute, money laundering, identity theft, and conspiracy to commit healthcare fraud. The charges relate to claims submitted to government healthcare programs, such as Medicaid and Medicare for treatments that were either medically unnecessary or never provided. In some cases, patient recruiters or others were allegedly paid illegal kickbacks in return for providing beneficiary information to medical providers so the providers could submit fraudulent bills to government healthcare programs.

U.S. Attorney Wifredo Ferrer, announced that the majority of the 73 Florida residents charged live in Miami-Dade County. The Florida residents charged include:

• Owners and operators of several pharmacies who are charged with paying Medicare beneficiaries for their personal identification numbers which in turn were used to submit false and fraudulent Medicare Part D claims for prescriptions.
• Owners and operators of a pharmacy who are charged with submitting false claims for drugs that were not medically necessary and were not provided. In addition, they allegedly submitted false drug wholesaler invoices to conceal that they had not purchased sufficient quantities of prescriptions drugs to have filled all of the prescriptions they had submitted to the government for payment.
• A doctor who is charged with submitting false claims to Medicare that home health care services were medically necessary and provided when, in fact, the services were neither necessary, nor provided.
• An owner and a director of nursing for a home health agency who are charged with creating false and fraudulent patient assessment forms stating that Medicare and Medicaid beneficiaries were qualified to receive home health care when they were not.
• Individuals who allegedly submitted fraudulent claims for physical therapy services that were not provided.
• An individual who is charged with submitting claims on behalf of his home health agency employer, but then having the payments sent to his home, which he then deposited in bank accounts that he alone controlled.
• An individual who is charged with laundering money that was used to conceal the payment of illegal kickbacks.
• Owners and operators of a behavioral health facility who are charged with paying patient recruiters and assisted living facility owners in exchange for patient referrals.

The Florida residents that have been charged were allegedly involved in defrauding Medicare and Medicaid out of approximately $263 million.