Largest Bust in Medicare Fraud Strike Force History
According to a recent Department of Justice press release, 107 doctors, nurses, and other health care professionals were charged with $452 million dollars of fraudulent Medicare billing in a single takedown by the Medicare Fraud Strike Force. The health care professionals were accused of fraud-based crimes such as conspiracy to commit health care fraud, health care fraud, kickback violations, and money laundering relating to “a variety of alleged fraud schemes involving various medical treatments and services such as home health care, mental health services, psychotherapy, physical and occupational therapy, durable medical equipment (DME) and ambulance services.”
The press release indicated that “the defendants allegedly participated in schemes to submit claims to Medicare for treatments that were medically unnecessary and oftentimes never provided.” It was also alleged 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 submit fraudulent billing to Medicare for services that were medically unnecessary or never provided.”
In a recent speech before the Greater Miami Chamber of Commerce, FBI Director Mueller discussed another recent success of the Medicare Fraud Strike Force:
One recent case here in Miami exemplifies today’s large-scale health care fraud. The American Therapeutic Corporation, the largest owner of community mental health centers in Florida, preyed on patients with severe dementia. Company officials forced patients to undergo unneeded treatment to inflate the amount of money the company received from Medicare. In some cases, owners of assisted living homes—and even patients themselves—received kickbacks to go along with the scheme. Over an eight-year period, company officials submitted over $200 million in fraudulent Medicare claims. Our investigation led to the indictment and arrest of 24 defendants. Last September, the corporation’s two owners were sentenced to 50 and 35 years in prison, respectively.
The highly successful Medicare Fraud Strike Force is a joint program of the Department of Justice and the Department of Health and Human Services that shares resources and collaborates with state and local authorities to investigate and prosecute perpetrators of Medicare fraud. A key component of the Medicare Fraud Strike Force’s success is its use of sophisticated data analysis techniques to identify suspicious concentration levels of billing.