DOJ Charges 91 in Medicare Fraud Sweep Totaling $430M in Suspected False Billing
By Elizabeth Murphy | October 4, 2012 3:06 pm

The Justice Department has indicted 91 health care workers, ranging from doctors to nurses to health care company owners, in a seven-city Medicare fraud takedown that has identified almost $430 million in fraudulent billing, including a particularly brazen scheme in which people supposedly being treated for mental illness were left to watch television instead.

The indictments reveal an “alarming and unacceptable trend,” said Attorney General Eric Holder on Thursday. “Such activities not only siphon precious taxpayer resources, drive up health care costs, and jeopardize the strength of the Medicare program — they also disproportionately victimize the most vulnerable members of society, including elderly, disabled and impoverished Americans.”

Assistant Attorney General Tony West, Secretary for Health and Human Services Kathryn Sebelius and Attorney General Eric Holder at an earlier event. (file photo by Ryan J. Reilly / Main Justice).

The sweep, completed over the previous 24 hours, is the latest by the Medicare Fraud Strike Force, which announced a 107-person, $452 million takedown in May. Those charged are facing felonies that could send some defendants to prison for years, or even decades.

Holder, along with Human and Health Services Secretary Kathleen Sebelius, said the crimes include health care fraud, money laundering and violations of anti-kickback statutes. The various schemes center on home health care, mental health services, psychotherapy and physical and occupational therapy, among others, they said. Some 30 health care providers have been suspended for face administrative action by HHS as a result of the investigation.

Sebelius, in her remarks, also took time to laud the Affordable Care Act.

“Today’s arrests put criminals on notice that we are cracking down hard on people who want to steal from Medicare,” she said. “The health care law gives us new tools to better fight fraud and make Medicare stronger. In addition to the arrests made today, HHS used new authority from the health care law to stop future payments to many of the health care providers suspected of fraud.”

The sweep hit individuals located in Miami, Los Angeles, Dallas, Houston, Brooklyn, Baton Rouge and Chicago. In terms of individuals charged, Miami saw the highest number at 33, who allegedly engaged in fraud schemes totaling $204.5 million in false billings, the DOJ said.

In Los Angeles, authorities uncovered a $49.2 million fraud scheme by Alpha Ambulance Inc., in which the company was providing ambulance rides that were medically unnecessary, the department said. The ruse is the largest ambulance fraud scheme ever prosecuted buy the strike force.

The Justice Department-HHS joint task force has charged more than 1,400 defendants since its inception in 2007. The alleged frauds from those individuals amounts to more than $4.8 billion in false billing, the department said.

At today’s announcement, Holder and Sebelius were joined by Assistant Attorney General Lanny Breuer, chief of the Justice Department’s Criminal Division; Kevin Perkins, FBI Associate Deputy Director; Daniel Levinson, HHS Inspector General; and Peter Budetti, Deputy Administrator for Program Integrity of the Centers for Medicare and Medicaid Services.

Breuer described a particularly brazen and heartless fraud carried out in Houston, where seven defendants have been charged with running a hospital that submitted approximately $158 million in fraudulent claims for partial hospitalization program, or PHP, services, which are designed to treat those with severe mental illness.

“These defendants allegedly bribed Medicare beneficiaries with cigarettes, food and coupons redeemable for items at the hospital’s ‘country stores,’ to entice them to attend the hospital’s PHPs,” Breuer said.  “But, instead of giving these beneficiaries real medical care, the hospital owners and operators allegedly plunked them in front of the television, and billed Medicare on their behalf, for millions of dollars in expensive mental health treatment.”

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One Comment

  1. MAngel says:

    Wonder why the DOJ didn’t make a sweep into Alabama and investigate Rob Riley?

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