90 Charged in Medicare Fraud Schemes

HHS Alleges Massive Amounts of False Billings
90 Charged in Medicare Fraud Schemes

Federal authorities announced May 13 that charges have been filed against 90 individuals in six states who are allegedly tied to Medicare fraud schemes responsible for $260 million worth of false billings.

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Among those charged as a result of the federal government's Medicare Fraud Strike Force investigation are 27 physicians, nurses and other medical professionals in Michigan, Florida, California, New York, Louisiana and Texas.

"This coordinated takedown is the seventh national Medicare fraud takedown in strike force history," according to the Department of Health and Human Services. The strike force is part of the Health Care Fraud Prevention & Enforcement Action Team, or HEAT, a joint initiative between the Department of Justice and HHS focused on preventing and deterring fraud and enforcing anti-fraud laws.

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

According to court documents, the defendants allegedly participated in schemes to submit claims to Medicare for treatments that were medically unnecessary and often 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 then submit fraudulent bills to Medicare for services that were medically unnecessary or never performed, HHS says.

Case Details

In Miami, a total of 50 defendants were charged for their alleged participation in various fraud schemes involving approximately $65.5 million in false billings for home healthcare and mental health services and pharmacy fraud.

Eleven individuals were charged after an investigation by the Houston Medicare Strike Force. For example, five Houston-area physicians were charged with conspiring to bill Medicare for medically unnecessary home health services.

Eight defendants were charged in Los Angeles for their alleged roles in schemes to defraud Medicare of approximately $32 million. In one case, a doctor was charged for causing almost $24 million in losses to Medicare through his own fraudulent billing and referrals for durable medical equipment, including more than 1,000 expensive power wheelchairs, and home health services that were not medically necessary or not provided.

In Detroit, seven defendants were charged for their alleged roles in fraud schemes involving approximately $30 million in false claims for medically unnecessary services, including home health services, psychotherapy and infusion therapy.

In Tampa, Florida, seven individuals were charged 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. In one case, five individuals were charged for their alleged roles in a $12 million healthcare fraud and money laundering scheme that involved billing Medicare using names of beneficiaries from Miami-Dade County for services purportedly provided in Tampa area clinics, 280 miles away. The defendants then allegedly laundered the proceeds through a number of transactions involving several shell entities.

In Brooklyn, New York, authorities announced the indictment of Syed Imran Ahmed, M.D., in connection with an alleged $85 million scheme involving billings for surgeries that never occurred. In addition, six other individuals, including a physician and two billers, 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 supposedly provided to these patients.

Since the inception of the Medicare Strike Force in March 2007, operations in nine locations have charged almost 1,900 defendants who collectively have falsely billed the Medicare program for almost $6 billion, HHS says.

About the Author

Marianne Kolbasuk McGee

Marianne Kolbasuk McGee

Executive Editor, HealthcareInfoSecurity, ISMG

McGee is executive editor of Information Security Media Group's HealthcareInfoSecurity.com media site. She has about 30 years of IT journalism experience, with a focus on healthcare information technology issues for more than 15 years. Before joining ISMG in 2012, she was a reporter at InformationWeek magazine and news site and played a lead role in the launch of InformationWeek's healthcare IT media site.

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