A nationwide sweep by the federal government’s Medicare Fraud Strike Force resulted in criminal charges against 243 individuals, including 46 doctors, nurses, and other health care professionals for their suspected participation in a multitude of Medicare and Medicaid fraud schemes that cost U.S. taxpayers $712 million, the Department of Health and Human Services (HHS) announced Thursday.
U.S. Attorney General Loretta Lynch said the sweep, which encompassed 17 metropolitan areas throughout the U.S., was the “largest criminal health care fraud takedown in the history of the Department of Justice,” both in the number of individuals charged and the amount of federal health care funds lost.
U.S. prosecutors charged the defendants with various health care fraud-related crimes, including conspiracy to commit health care fraud, violations of the anti-kickback statutes, money laundering, and aggravated identity theft.
The charges stem from a variety of alleged fraud schemes involving various medical treatments and services, including home health care programs, psychotherapy, physical and occupational therapy, medical equipment, and pharmacy fraud.
According to court documents, the individuals charged participated in schemes to submit claims to Medicare and Medicaid for medically unnecessary treatments and for treatments that they often never provided.
In many cases, patient recruiters, Medicare beneficiaries, and other co-conspirators were paid cash kickbacks in return for supplying beneficiary information to health care providers, so that the providers could then submit fraudulent bills to Medicare for services that weren’t needed or were never performed, federal prosecutors allege.
More than 44 of the defendants arrested are charged with fraud related to the Medicare prescription drug benefit program known as Part D, which is the fastest-growing component of the Medicare program overall.
Most of the alleged fraud occurred in the metropolitan areas of Miami, Houston and McAllen, Dallas, Los Angeles, Detroit, Tampa, Brooklyn, N.Y., and New Orleans.
“Health care fraud drives up health care costs, wastes taxpayer money, undermines the Medicare and Medicaid programs, and endangers program beneficiaries,” said HHS Inspector General Daniel Levinson. “Today’s takedown includes perpetrators of prescription drug fraud, home health care fraud, and personal care services fraud, three particularly harmful types of fraud plaguing our health care system.”