Medical professionals charged with fraud involving Medicare

A strike force of federal, state and local agents and investigators, led by the Departments of Justice and Health and Human Services, has charged 107 persons in seven cities with Medicare fraud involving more than $452 million in false billings, Attorney General Eric H. Holder Jr. said Wednesday.

Mr. Holder, joined during a news conference by HHS Secretary Kathleen Sebelius, described the sweep as the highest amount of apparent false Medicare billings involved in a single takedown in the five-year history of the government’s Medicare Fraud Strike Force.

Those charged included doctors, nurses, social workers, health care company owners and others - all accused of a range of serious offenses, including health care fraud, conspiracy to commit health care fraud, money laundering and violation of laws against kickbacks.

The charges are based on a variety of purported schemes involving various medical treatments and services such as home health care, mental health services, psychotherapy, physical and occupational therapy, medical equipment and ambulance services.

The arrests were made in Los Angeles, Chicago, Miami, Houston, Detroit, Baton Rouge, La., and Tampa, Fla. More than 500 agents and investigators nationwide, from the FBI and state and local officers to the HHS office of the inspector general and multiple Medicare fraud control units took part in the operation.

According to court documents, those charged were accused of participating in schemes to submit claims to Medicare for treatments that were medically unnecessary and often never provided. In many cases, the records show patient recruiters, Medicare beneficiaries and other co-conspirators were paid cash kickbacks in return for supplying beneficiary information to providers, so the providers could submit fraudulent bills to Medicare.

Mr. Holder said the agents and investigators launched numerous extensive investigations, and have arrested or taken into custody 91 of the charged defendants. In addition to making arrests, agents also executed 20 search warrants in connection with the investigations.

“I am grateful to - and proud of - each one of them. Their actions underscore the Justice Department’s determination to move aggressively in bringing to justice those who would violate our laws and defraud the Medicare program for personal gain,” he said.

“And their work is at the heart of an administrationwide commitment to protecting the American people from all forms of health care fraud, which - as we’ve seen in far too many communities - can drive up health care costs and even threaten the strength and integrity of our entire health care system,” he said.

Mr. Holder said the agents and investigators were part of a joint initiative known as the Health Care Fraud Prevention and Enforcement Action Team, or HEAT, aimed at leveraging the strength of federal, state and local partnerships in taking the fight against health care fraud to a new level.

A driving force behind HEAT’s success, he said, has been the criminal Medicare strike forces, which have charged more than 1,330 persons with more than $4 billion in false billings. During the past three fiscal years, he said, for every dollar the government has spent confronting health care fraud, it has returned an average of $7 to the U.S. Treasury and other Medicare trust funds.

“Despite these remarkable results, much more remains to be done,” Mr. Holder said. “Fortunately, our determination to build on the progress we’ve made - and to strengthen the partnerships we’ve established across all levels of government and law enforcement - has never been stronger. And, as today’s historic announcement proves our approach has never been more effective.”