Strike force alleges nearly $430 million in Medicare fraud


The long arm of the law – in the form of the Medicare Strike Force – extended its reach into seven cities on Oct. 4 with the unsealing of indictments against 91 people accused of fraudulent billing amounting to nearly $430 million.

[See also: Fraudulent online pharmacies prompt FDA to fight back with new resource]

Those charged include doctors, nurses and other medical professionals, according to the U.S. Department of Health & Human Services (HHS) and the Justice Department, which jointly announced the actions.

“[The] enforcement actions reveal an alarming and unacceptable trend of individuals attempting to exploit federal healthcare programs to steal billions in taxpayer dollars for personal gain,” said Attorney General Eric Holder, in a press release. “Such activities not only siphon precious taxpayer resources, drive up healthcare 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.”

The indictments were handed down in Miami, Los Angeles, Dallas, Houston, Brooklyn, N.Y., Baton Rouge, La., and Chicago. In all, the indictments charge more than $230 million in home healthcare fraud, more than $100 million in mental healthcare fraud and more than $49 million in ambulance transportation fraud.

Charges range from conspiracy to commit healthcare fraud, healthcare fraud, violations of the anti-kickback statutes and money laundering.

In Miami, the alleged fraud resulted in charges against 33 for their participation in schemes involving a total of $204.5 million in false billings for home healthcare, mental health services, occupational and physical therapy, and durable medical equipment. 

Two Miami cases alone totaled more than $141 million in alleged false billing for home healthcare and mental health services.

In Los Angeles, the task force uncovered what it termed the largest ambulance fraud scheme it has ever prosecuted: The indictment reported $49.2 million in false charges from Alpha Ambulance Inc., which resulted in the arrest of four people.

“Today’s coordinated operation demonstrates that law enforcement is flexible enough to address healthcare fraud in its many evolving forms,” said HHS Inspector General Daniel Levinson, in a prepared statement. “When home health agencies, durable medical equipment companies, pharmacies or other healthcare providers are suspected of breaking the law, they can expect to be caught and held accountable.”

In addition to the indictments, the task force also announced it was taking administrative action on 30 healthcare providers based on data analysis that showed credible evidence of fraud. Using a statue of the Affordable Care Act, the agency has suspended payments to those providers pending the completion of an investigation into their billing practices.

“The healthcare law gives us new tools to better fight fraud and make Medicare stronger,” noted HHS Secretary Kathleen Sebelius in a press release announcing the actions. “In addition to the arrests made today, HHS used new authority from the healthcare law to stop future payments to many of the healthcare providers suspected of fraud, saving Medicare resources and taxpayer dollars from being lost to fraud in the first place.”

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