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U.S. charges 243 individuals for $712 million Medicare fraud

por Lauren Dubinsky, Senior Reporter | June 19, 2015
Risk Management
The U.S. Justice Department brought charges against 243 individuals including 46 doctors, nurses and other medical professionals for allegedly being involved in Medicare fraud worth about $712 million. This is the largest criminal health care fraud takedown in the history of the Department of Justice.

In addition, CMS used its suspension authority provided by the Affordable Care Act to suspend a number of providers.

The defendants were charged with crimes including conspiracy to commit health care fraud, violations of the anti-kickback statutes, money laundering and aggravated identity theft. The false billings involved medical treatments and services including home health care, psychotherapy, physical and occupational therapy, durable medical equipment and pharmacy fraud.

“This record-setting takedown sends a message to would-be perpetrators that health care fraud is a risky way to line your pockets,” Inspector General Daniel R. Levinson of the HHS Office of Inspector General, said in a statement. “Our agents and our law enforcement partners stand ready to protect these vital programs and ensure that those who would steal from federal health care programs ultimately pay for their crimes.”

In many of the cases, patient recruiters, Medicare beneficiaries and other co-conspirators were allegedly paid cash kickbacks for supplying beneficiary information to providers so they could submit fraudulent bills to Medicare for services that were unnecessary or never performed, according to court documents.

The Justice Department’s Criminal Division is becoming more strategic in its approach to prosecuting Medicare fraud. They are now analyzing billing data in real time and targeting areas of the country and types of health care services that have the potential for a high amount of fraud.

The Medicare Fraud Strike Force operations, which led the nationwide fraud sweep, are part of the Health Care Fraud Prevention & Enforcement Action Team — Department of Justice and HHS initiative to focus their efforts to prevent fraud and enforce current anti-fraud laws. Since it began in March 2007, Strike Force operations are located in nine locations and have charged more than 2,300 defendants who collectively falsely billed Medicare over $7 billion.

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