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Historic Medicare fraud takedown: Feds charge 243 people with $712M in false billing

Largest coordinated strike includes defendants in major cities from Miami to Los Angeles

The Department of Justice (DOJ) and the Department of Health and Human Services (HHS) have charged 243 individuals involved in false billing schemes totaling $712 million in cities across the country as part of a coordinated healthcare fraud takedown led by the Medicare Fraud Strike Force, according to a DOJ announcement Thursday.

The historic takedown is the largest in the DOJ's history, nearly three times the size of last year's nationwide sweep that charged 90 individuals in six different cities. The sweep includes a variety of fraud schemes ranging from anti-kickback violations, aggravated identity theft, and conspiracy to commit healthcare fraud involving home health, mental health, occupational therapy, durable medical equipment and pharmaceutical fraud.

"This action represents the largest criminal healthcare fraud takedown in the history of the Department of Justice, and it adds to an already remarkable record of enforcement," Attorney General Loretta E. Lynch said in the announcement. "In the days ahead, the Department of Justice will continue our focus on preventing wrongdoing and prosecuting those whose criminal activity drives up medical costs and jeopardizes a system that our citizens trust with their lives."

Forty-four of the 243 individuals were charged with prescription drug fraud tied to Medicare Part D, a federal health program that has faced scrutiny over the past year. Last March, the Office of Inspector General called on the Centers for Medicare & Medicaid Services (CMS) to improve Part D anti-fraud oversight. Months later, CMS followed up with a new rule that provided enhanced fraud prevention tools for the Part D program.

The takedown also marked the first time that districts outside of the Medicare Strike Force participated in the coordinated sweep, accounting for 82 of the charged individuals. The largest chunk of defendants hailed from South Florida, an area in which fraud has been labeled "endemic" for the last several years. Seventy-three individuals from Miami face fraud-related charged linked to approximately $263 million in false claims. In one instance, administrators at a Miami mental health facility allegedly billed $64 million in false claims during a six-year period for intensive mental health treatment and paid kickbacks to patient recruiters and operators of assistant living facilities that referred Medicare beneficiaries.

Dallas, Los Angeles, Houston, Detroit, Tampa Bay and New Orleans were among the other notable cities involved in the raid. In Detroit, 16 individuals, including three owners of hospice services, face charges for false claims totaling $122 million. In Dallas, six owners of a physician house call service billed Medicare $43 million under one physician's name.

Including Thursday's announcement, federal takedowns have charged 900 individuals with fraud schemes totaling more than $2.5 billion.

For more:
- read the DOJ announcement

Related Articles:
Medicare fraud takedown nabs 90 in 6 cities
OIG to CMS: Ramp up Part D anti-fraud oversight
New Medicare rules target Part D fraud and abuse
Tighter controls, oversight will mitigate endemic fraud in South Florida
An inside peek at the Medicare Strike Force