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From Health Law Daily, May 15, 2013

Nationwide takedown leads to 89 individuals charged with $223 million in fraudulent billing to Medicare

By Sarah E. Baumann, JD

A national Medicare fraud takedown conducted by the Medicare Fraud Strike Force resulted in charges against 89 people for $223 million in false billing, Attorney General Eric Holder and HHS Secretary Kathleen Sebelius announced. Four hundred law enforcement agents from various federal, state, and local agencies participated in the takedown, which led to the arrests of the alleged perpetrators, nearly one quarter of whom are doctors, nurses, physical therapists, or other medical professionals. The arrests resulted from Strike Force operations in Miami, Baton Rouge, Houston, Los Angeles, Detroit, Tampa, Chicago, and Brooklyn.

Allegations. The defendants allegedly committed a variety of crimes involving the improper securing of Medicare information from elderly or low-income individuals and the submission of false billings for treatments that never occurred, or were performed by unlicensed individuals. The activity occurred in various health care fields, but most notably in the home health industry. In Miami and Baton Rouge, for example, investigations uncovered multimillion dollar schemes involving a handful of perpetrators that involved bribing beneficiaries for Medicare information and billing Medicare for medically unnecessary services or services that were never rendered. Other cases involved fraudulent billing for power wheelchairs, surgeries that were never performed, and massages by unlicensed therapists. In one notable Detroit scheme, three defendants falsely held themselves out as licensed physicians, conducting examinations, writing prescriptions for drugs, including narcotics, and signing off on psychotherapy documents.

Anti-fraud operations. This is the sixth national Medicare fraud takedown coordinated by the Medicare Fraud Strike Force, which was created in 2007. The Strike Force is part of the Health Care Fraud Prevention & Enforcement Action Team (HEAT) initiative that combines the resources of the Department of Justice (DOJ) and HHS. Attorney General Holder stated that Strike Force operations over the last three fiscal years have resulted in recoupment of nearly eight dollars for every dollar spent on combating health care fraud. Additionally, he suggested that Strike Force actions have deterred illegal activity, noting that group psychotherapy bills to Medicare decreased by more than 70 percent after the Strike Force targeted group psychotherapy fraud in Detroit and that billings for home health services in Florida dropped by more than $1 billion after the Miami team targeted home health fraud. Holder expressed concern that sequestration, which cut more than $1.6 billion from the DOJ’s FY 2013 budget and is expected to continue into FY 2014, will reduce the DOJ’s ability to combat Medicare fraud.

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