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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.

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