Medicare Fraud Takedown Leads to 53 Indictments

Medicare fraud schemes to falsify over $50 million in Medicare claims have been thwarted by ongoing government strike force operations. A total of 53 indictments have made thus far. Among those having charges filed against them are doctors, health care executives, and beneficiaries for alleged fraudulent Medicare billing in Detroit, Michigan. The takedown by the Medicare Fraud Strike Force has lead to indictments being returned by a grand jury, with additional arrests being made in Miami, Florida and Denver Colorado.

The announcement of the takedown came from Attorney General Eric Holder, Department of Health and Human Services (HHS) Secretary Kathleen Sebelius, and the FBI Director Robert Mueller. The Detroit Strike Force marks the third phase of combined criminal, civil, and administrative efforts in targeting a crackdown on both health care companies and individuals that submit fraudulent claims to Medicare. The joint Department of Justice (DOJ)-HHS Medicare Fraud Strike Force is comprised of a team of federal, state, and local investigators from multiple agencies. The purpose of the strike force is to battle against Medicare fraud by utilizing Medicare data analysis techniques and focusing on community policing.

The Strike Force is part of the Health Care Fraud Prevention & Enforcement Action Team (HEAT), that combines the effort of the DOJ and HHS in the prevention of fraud as well as for the enforcement of current anti-fraud laws across the U.S. Deputy Attorney General David Ogden and Deputy Secretary Bill Corr co-chair the HEAT taskforce that encompasses senior level law enforcement agents and prosecutors, their staff members, and the staff members of their operating divisions.

In May of 2009, Attorney General Holder and Secretary Sebelius announced both renewed efforts of the HEAT team in focusing on fraud prevention and the expansion of the Strike Force to include Detroit, Michigan and Houston, Texas in targeting fraud reduction and the recovery of taxpayer dollars.

Among the charges made against the 53 indicted individuals are conspiracy to defraud the Medicare program, criminal false claims and violations of the anti-kickback statutes. Two primary areas have been identified in the schemes to commit fraud against Medicare including infusion therapy and physical/occupational therapy providers. Regarding the takedown, Attorney General Holder warned, “As demonstrated by today’s charges and arrests, we will strike back against those whose fraudulent schemes not only undermine a program upon which 45 million aged and disabled Americans depend, but which also contribute directly to rising health care costs that all Americans must bear.” He went on to say, “The vast majority of doctors, patients, and medical companies do the right thing and work with the Medicare program to provide access to medical services. To those who work diligently and ethically to provide medical care through the Medicare program, we will work with you to root out the few who corrupt the system and taint the good reputations of health professionals everywhere.”

The indictments revealed that the charged defendants willingly took part in schemes to submit Medicare claims for treatments that were not only medically unnecessary but many of which were never provided. A number of the indictments allege that beneficiaries received cash kickbacks in return for allowing providers to submit claims for the unnecessary and non-provided treatments.

The more than $50 million in fraudulent claims to Medicare were made by a collective conspiracy among physicians, medical assistants, patients, company owners and executives. Anyone contemplating future acts of fraud against the Medicare program should carefully ponder the words of FBI Director Mueller, who stated,  “We will continue to work together in the months to come to identify and stop those who would line their own pockets with taxpayer money – those who seek to benefit at the expense of our health care system, our economy and our collective well-being.”