$452 Million in Medicare Fraud Alleged

107 Charged in Seven-City Crackdown
$452 Million in Medicare Fraud Alleged

Federal authorities this week have charged 107 individuals, including some physicians and nurses, for their alleged participation in schemes involving $452 million in false Medicare billing.

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The coordinated fraud crackdown took place in seven cities, including Miami, where 59 were charged, according to Kathleen Sebelius, secretary of the Department of Health and Human Services, and Attorney General Eric Holder. The alleged schemes involved home healthcare, mental health services, psychotherapy, physical and occupational therapy, durable medical equipment and ambulance services, an HHS announcement notes.

The defendants allegedly participated in schemes to submit claims to Medicare for treatments that were medically unnecessary or 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 bills.

The defendants are charged with such crimes as conspiracy to commit healthcare fraud, healthcare fraud, violations of the anti-kickback statutes and money laundering.

In addition, federal authorities suspended from the Medicare program or took other administrative action against 52 healthcare providers suspected of fraud.

The coordinated effort involved the highest amount of false Medicare billings in a single takedown by the Medicare Fraud Strike Force, authorities say. The strike force is part of the Health Care Fraud Prevention & Enforcement Action Team, a joint initiative between HHS and the Justice Department.

About the Author

Howard Anderson

Howard Anderson

Former News Editor, ISMG

Anderson was news editor of Information Security Media Group and founding editor of HealthcareInfoSecurity and DataBreachToday. He has more than 40 years of journalism experience, with a focus on healthcare information technology issues. Before launching HealthcareInfoSecurity, he served as founding editor of Health Data Management magazine, where he worked for 17 years, and he served in leadership roles at several other healthcare magazines and newspapers.

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