91 individuals, including doctors, nurses, and licensed medical professionals, have been charged with allegedly participating in Medicare fraud schemes involving approximately $429.2 million in false billing, the Justice Department announced today.
Attorney General Eric Holder and Health and Human Services (HHS) Secretary Kathleen Sebelius revealed the nationwide takedown, which involved operations in seven cities. The joint Department of Justice and HHS Medicare Fraud Strike Force is a multi-agency team of federal, state, and local investigators and prosecutors designed to combat Medicare fraud through the use of Medicare data analysis techniques.
“Today’s enforcement actions reveal an alarming and unacceptable trend of individuals attempting to exploit federal health care programs to steal billions in taxpayer dollars for personal gain,” said Attorney General Holder. “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.”
Dozens of charged individuals were arrested or surrendered in the last 24 hours as indictments were unsealed across the country. Together, those indictments charge more than $230 million in home health care fraud, more than $100 million in mental health care fraud, and more than $49 million in ambulance transportation fraud, and millions more in other frauds.
HHS also suspended or took other administrative action against 30 health care providers following a data-driven analysis and based upon credible allegations of fraud. Under the Affordable Care Act, HHS is able to suspend payments until the resolution of an investigation.
The defendants charged are accused of various health care fraud-related crimes, including conspiracy to commit health care fraud, health care fraud, violations of the anti-kickback statutes, and money laundering. The charges are based on 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, and ambulance services.
The joint operation involved more than 500 law enforcement agents from the FBI, HHS-OIG, multiple Medicaid Fraud Control Units, and other state and local law enforcement agencies. The defendants allegedly participated in schemes to submit claims to Medicare for treatments that were medically unnecessary and oftentimes never provided.
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