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Feds Charge 91 Medical Professionals With $430M in Medicare Fraud

Posted in Healthcare Services Investing

The joint Department of Justice and Health and Human Services (HHS) Medicare Fraud Strike Force has charged 91 medical professionals in seven cities for allegedly participating in Medicare fraud schemes involving approximately $429.2 million in false billing. The defendants, who include physicians and nurses, are accused of various fraud-related crimes, including healthcare fraud, violations of the anti-kickback statutes, money laundering, and conspiracy to commit healthcare fraud.

Charges were filed in Miami, Los Angeles, Dallas, Houston, Brooklyn (N.Y.), Baton Rouge (La.) and Chicago. The indictments include more than $230 million in home healthcare fraud and more than $100 million in mental healthcare fraud. Also included are charges of more than $49 million in ambulance transportation fraud in Los Angeles, which authorities called the largest ambulance fraud scheme ever prosecuted by the strike force.

In addition to filing the charges, HHS also suspended or took other action against 30 providers based upon credible allegations of fraud. Under the Affordable Care Act, HHS has the authority to suspend payments until completion of an investigation. "In addition to the arrests made today, HHS used new authority from the healthcare law to stop future payments to many of the healthcare providers suspected of fraud, saving Medicare resources and taxpayer dollars from being lost to fraud in the first place," said HHS Secretary Kathleen Sebelius.

This latest raid comes after the Medicare Fraud Strike Force charged, in early May, 107 individuals in seven cities for their alleged participation in Medicare fraud schemes involving approximately $452 million in false billing.

Over the past five years, strike force operations have led to Medicare fraud charges against nearly 1,500 defendants in cases totaling almost $5 billion. These investigations and President Obama’s comments during the recent presidential debate about how aggressively his administration has pursued Medicare fraud are yet further indications of the federal government’s focus on healthcare fraud prevention, of which investors and providers should be constantly aware.