Doctor concerned with health care law

Breaking news and expert analysis on legal and compliance issues

[Back To Home][Back To Archives]

From Health Law Daily, May 13, 2014

Justice Department, OIG coordinate multi-region arrests for Medicare fraud

By Michelle L. Oxman, JD, LLM

The HHS Office of Inspector General (OIG) and the Department of Justice announced on May 13, 2014 the arrest of 89 individuals in Miami, Houston, Los Angeles, Detroit, Brooklyn, New York, and Tampa for $260 million in Medicare fraud. Of those arrested, 27 were health care professionals, including 16 doctors. The national take-down, the seventh in the history of the Medicare Fraud Strike Force, was a cooperative effort among the Criminal Division of the Department of Justice, the U.S. Attorney’s Offices in each district, the FBI, and local law enforcement agencies.

Typical schemes. The alleged fraudulent schemes were typical of Medicare fraud throughout the country, including:

  • Health care practitioners billing for services that were not medically necessary and/or were never furnished;

  • Payment for Medicare identification numbers in order to bill Medicare for nonexistent services; and

  • Billing for motorized wheelchairs that were not needed;

The services that were billed but not furnished included home health care, outpatient psychology and behavioral health; pharmaceuticals, durable medical equipment, and physician and physical therapy services.

Regional schemes. In Miami alone, 50 people were charged with billing $65.5 million in fraudulent claims to Medicare for home health care, mental health services, and pharmacy services. In Houston, 11 people, including five physicians were charged with filing false Medicare claims for home health care, while in Los Angeles, eight defendants are charged with fraud totaling $32 million.

Two schemes allegedly uncovered in Brooklyn, New York allegedly involved nearly $100 million, including $85 million billed by one physician for surgeries that never took place. In Tampa, seven people allegedly participated in several schemes involving claims for nonexistent physician services and diagnostic testing. They also allegedly billed for services purportedly provided in Tampa to individuals who lived nearly 300 miles away in Miami-Dade County. The Tampa claims amount to $12 million and also involved money laundering using shell entities.

MainStory: TopStory NewsStory FraudNews ComplianceNews BillingNews ProviderNews DMENews HomeNews

Health Law Daily

Introducing Wolters Kluwer Health Law Daily — a daily reporting service created by attorneys, for attorneys — providing same-day coverage of breaking news, court decisions, legislation, and regulatory activity.

A complete daily report of the news that affects your world

  • View full summaries of federal and state court decisions.
  • Access full text of legislative and regulatory developments.
  • Customize your daily email by topic and/or jurisdiction.
  • Search archives for stories of interest.

Not just news — the right news

  • Get expert analysis written by subject matter specialists—created by attorneys for attorneys.
  • Track law firms and organizations in the headlines with our new “Who’s in the News” feature.
  • Promote your firm with our new reprint policy.

24/7 access for a 24/7 world

  • Forward information with special copyright permissions, encouraging collaboration between counsel and colleagues.
  • Save time with mobile apps for your BlackBerry, iPhone, iPad, Android, or Kindle.
  • Access all links from any mobile device without being prompted for user name and password.