107 charged in nationwide Medicare fraud sting

Federal investigators charged 107 people, including physicians and other health professionals, for allegedly scheming to commit Medicare fraud by submitting a combined $452 million in false claims, officials said.

Coordinated law enforcement actions in seven cities led to charges of conspiracy to commit health care fraud, violations of the anti-kickback statutes and money laundering, Dept. of Health and Human Services and Justice Dept. officials announced May 2. Allegations included fraud schemes involving home health care, mental health services, psychotherapy, physical and occupational therapy, medical equipment and ambulance services.

The coordinated takedown involved the highest amount of alleged false Medicare billings in program history.

“Today’s arrests send a strong message to criminals that the consequences of committing Medicare fraud are serious,” HHS Secretary Kathleen Sebelius said. “In addition to these arrests, we used new authority from the health care law to stop all future payments to 52 health care providers suspected of fraud before they are ever made.”

Court documents allege the defendants had submitted claims for services that were medically unnecessary or never provided. In some cases, patient recruiters were used and beneficiaries were promised kickbacks for their participation, HHS said.

Officials executed 20 search warrants leading to the federal charges. In Miami, 59 people were charged in connection with health fraud schemes totaling $137 million. Another alleged fraud enterprise involving $225 million in false billing for community mental health center services led to the arrest of seven individuals in Baton Rouge, La.

In Washington, a bipartisan group of six senators has promised to explore new ways to stop fraud in federal health programs. The members of the Senate Finance Committee wrote a May 2 letter to physicians, hospitals and health professionals. The letter requested ideas “regarding solutions and suggestions for how to better prevent and combat the multibillion-dollar problem of waste, fraud and abuse in the Medicare and Medicaid programs.”

Note: This item originally appeared at http://www.ama-assn.org/amednews/2012/05/14/gvbf0514.htm.