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DOJ Charges 107 in Medicare Frauds Said to Total $452 Million
Posted By David Stout On May 2, 2012 @ 2:25 pm In News | Comments Disabled
The Department of Justice said on Wednesday that it has charged 107 people, including at least three doctors, several nurses and various other health care professionals, in Medicare fraud schemes that were remarkable for their breadth, brazenness and the money involved: some $452 million in false billings.
Fraud schemes in seven cities — Miami, Tampa, Baton Rouge, Los Angeles, Houston, Detroit and Chicago — were taken down by Medicare Fraud Strike Force operations, the DOJ said . The biggest fraud scheme in terms of defendants was in Miami, where 59 people are accused of submitting $137 million in false billings, while the biggest in dollar terms was in Baton Rouge, where $225.6 million in false billings were submitted by just seven defendants, the DOJ said.
The frauds alleged by the DOJ were carried out roughly from the middle of the last decade until 2011. It was not immediately clear how much government money was actually lost, since the city-by-city figures cited are of allegedly false billings rather than money paid out. Nevertheless, the money actually stolen by two defendants in Louisiana was “astounding,” one legal document says.
“This coordinated takedown involved the highest amount of false Medicare billings in a single takedown in strike force history,” the DOJ said in a statement  issued as Attorney General Eric Holder and the Health and Human Services Secretary, Kathleen Sebelius, announced the sweep.
The Baton Rouge operation, as described in legal documents in the Middle District of Louisiana, also included an incident of astounding over-confidence. Defendant Roslyn F. Dogan, director of a health care company set up to take advantage of Medicare, and some co-conspirators gained access in 2011 to documents in the United States Attorney’s offices via the discovery process in a civil suit, prosecutors said.
“Dogan and co-conspirators bragged that, while pretending to copy files, they actually stole incriminating documents from the files and later destroyed them,” according to a memo urging that Dogan be denied bail. “Dogan also celebrated the fact that, in the search, the investigators missed a lot of important information, such as employee time cards,” the memo relates.
Among the nine defendants in the Southern District of Florida is Armando Gonzalez, who ran a health care outfit that did business in Miami and Hendeson, N.C. As described by the government, Gonzales traveled between Florida and North Carolina, sometimes finding patients through kickbacks to recruiters.
In many instances, the suspects billed the government for mental health treatments that were never provided, or were improper or unnecessary, thus cheating not only the taxpayers but patients who were among the most vulnerable, the officials said.
“The results we are announcing today are at the heart of an Administration-wide commitment to protecting American taxpayers from health care fraud, which can drive up costs and threaten the strength and integrity of our health care system,” Holder said in the statement. “We are determined to bring to justice those who violate our laws and defraud the Medicare program for personal gain. As today’s takedown reflects, our ongoing fight against health care fraud has never been more coordinated and effective.”
It was clear from documents released by the DOJ that prosecutors have secured the cooperation of several witnesses, some of whom have already pleaded guilty in the hope of minimizing their punishment. As for the targets of the various investigations, many could go to prison for decades, or for the rest of their lives.
Those whose indictments were announced on Wednesday are accused of a range of crimes, including conspiracy, health care fraud and money laundering. The DOJ and HHS have made health care fraud a top priority, as evidenced by February’s announcement of a huge Texas fraud case, as reported  by Main Justice. The departments recently announced  a record year for recovery of money in fraud schemes.
In addition to doctors and nurses, the 107 people who face charges include bookkeepers, therapists and at least one pharmacist, the DOJ said. The DOJ gave these numbers for the other cities where anti-fraud operations have been carried out: Los Angeles, eight defendants and $14.1 in false billings; Houston, nine defendants and $16.4 million; Detroit, 22 defendants and $58 million; Chicago, one defendant and $1 million, and Tampa, one defendant (the pharmacist) and little or no money.
The DOJ and HHS announcement was flavored by a bit of politics, as shown in the remarks by Sebelius. “Today’s arrests send a strong message to criminals that the consequences of committing Medicare fraud are serious,” she said. “In addition to these arrests, we used new authority from the health care law to stop all future payments to 52 health care providers suspected of fraud before they are ever made. Today’s actions are another example of how the Affordable Care Act is helping the Obama Administration fight fraud and strengthen the Medicare program.”
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