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DOJ: Medicare Fraud Strike Force Charges 90 Individuals for Approximately $260 Million in False Billing




by:
Diane T. Carter
Husch Blackwell LLP - Austin Office

 
May 19, 2014

Previously published on May 13, 2014

The U.S. Department of Justice issued a press release (the “press release”) covering today’s announcement by Attorney General Eric Holder and Department of Health & Human Services (HHS) Secretary Kathleen Sebelius that Medicare Fraud Strike Force operations in six cities resulted in charges against 90 individuals, including 27 doctors, nurses and other medical professionals, for their alleged participation in fraud schemes involving approximately $260 million in Medicare false claims.

According to the press release, the defendants charged are accused of various health care fraud-related crimes, including conspiracy to commit health care fraud, violations of the federal anti-kickback statutes, and money laundering. The charges are based on a variety of alleged fraud schemes involving various medical treatments and services, including home health care, mental health services, psychotherapy, physical and occupational therapy, durable medical equipment, and pharmacy fraud.

The defendants allegedly participated in schemes to submit claims to Medicare for treatments that were medically unnecessary or never provided. In many cases, it is alleged 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 then submit fraudulent bills to Medicare for services that were medically unnecessary or never performed.

The Medicare Fraud Strike Force operations are part of the Health Care Fraud Prevention & Enforcement Action Team (“HEAT”), a joint nationwide initiative announced in May 2009 between the Department of Justice and HHS to prevent and deter fraud and enforce anti-fraud laws around the country. HEAT is a multi-agency team of federal, state, and local investigators designed to combat Medicare fraud through the use of Medicare data analysis techniques and community policing. Almost 400 law enforcement agents from the FBI, HHS-OIG, multiple Medicaid Fraud Control Units and other federal, state and local law enforcement agencies participated in this effort. Since its inception, the Department of Justice’s Medicare Fraud Strike Force has charged nearly 1,900 individuals involved in approximately $6 billion of fraud.

According to the press release:

  • Fifty defendants were charged in Miami in the strike for their alleged participation in various fraud schemes involving approximately $65.5 million in false billings for home health care and mental health services, and pharmacy fraud;
  • Eleven individuals were charged by the Houston Medicare Strike Force, including five Houston-area physicians charged with conspiring to bill Medicare for medically unnecessary home health services;
  • Eight defendants were charged in Los Angeles for their roles in schemes to defraud Medicare of approximately $32 million, including a doctor charged for causing almost $24 million in losses to Medicare through fraudulent billing and referrals for durable medical equipment and home health services that were not medically necessary and frequently not provided;
  • Seven defendants were charged in Detroit for their roles in fraud schemes involving approximately $30 million in false claims for medically unnecessary services, including home health services, psychotherapy and infusion therapy;
  • Seven defendants were charged in Tampa, Florida, in a variety of schemes ranging from fraudulent physical therapy billings to a scheme involving millions of dollars in physician services and tests that never occurred; and
  • In Brooklyn, New York, the Strike Force announced an indictment against Syed Imran Ahmed, M.D., in connection with his alleged $85 million scheme involving billings for surgeries that never occurred for which Dr. Ahmed had been arrested last month and charged by complaint. In addition, the Brooklyn Strike Force charged six other individuals, including a physician and two billers who allegedly concocted a $14.4 million scheme in which they recruited elderly Medicare beneficiaries and billed Medicare for medically unnecessary vitamin infusions, diagnostic tests and physical and occupational therapy.


 

The views expressed in this document are solely the views of the author and not Martindale-Hubbell. This document is intended for informational purposes only and is not legal advice or a substitute for consultation with a licensed legal professional in a particular case or circumstance.
 

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Diane T. Carter
Practice Area
 
Government
 
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