Medicare Fraud Sweep Catches 91 Healthcare Professionals

In a Medicare fraud sweep covering seven cities, federal authorities arrested 91 healthcare professionals, including many doctors and nurses. The Medicare fraud schemes in which they took part fraudulently billed the Medicare program $429.2 million, reported MedPage Today.

Defendants in Seven Cities Allegedly Involved in $429.2 Million Medicare Fraud Schemes

The Medicare fraud schemes all involved billing Medicare for healthcare services that were medically unnecessary and/or were never actually provided, and they produced profits of over $230 million in home healthcare fraud; over $100 million in mental healthcare fraud, and over $49 million in ambulance transportation fraud.

According to the Justice Department, the fraud schemes involved the following cities:

• Miami: 33 defendants have been charged with participating in Medicare fraud schemes involving $204.5 million in fraudulent billing for home healthcare services, mental health services, durable medical devices (DME), and physical and occupational therapy. Three defendants alone were allegedly responsible for $74 million in false claims against the Medicare program.
• Los Angeles: 16 defendants, including three doctors and one physical therapist, have been charged with participating in Medicare fraud schemes involving $53.8 million in fraudulent billing. Four defendants alone engaged in an ambulance transportation fraud scheme that resulted in more than $49 million in false claims against the Medicare program.
• Dallas: 14 defendants, including two doctors and two R.N.s, have been charged with participating in fraud schemes involving $103.3 million in fraudulent Medicare billing. Three of those defendants engaged in Medicare fraud that resulted in about $100 million in false claims for home healthcare services.
• Houston: Seven defendants have been charged with participating in a Medicare fraud scheme involving $158 million in false claims for community mental health services. Hospital administrators allegedly paid kickbacks to Medicare beneficiaries in exchange for their participation in the hospitals partial hospitalization program (PHP). The hospital billed Medicare for PHP treatment, although the patients did not actually participate in treatment, but rather watched television and played games.
• Brooklyn: 15 defendants, including a doctor and four chiropractors, have been charged with participating in Medicare fraud schemes involving $23.2 million in false claims.
• Baton Rouge: Four defendants, including an L.P.N., have been charged with participating in Medicare fraud schemes involving $2.4 million in fraudulent billing for medically unnecessary DME.
• Chicago: Two defendants, including a psychologist and a dermatologist, have been charged with participating in Medicare fraud schemes involving millions of dollars in medically unnecessary psychotherapy and laser treatments.

Whistleblowers Can Help Stop Widespread Medicare Fraud

Medicare fraud must be stopped. Often whistleblowers have access to the evidence that will allow federal authorities to successfully fight Medicare fraud. Information from whistleblowers is so vital to the battle against Medicare fraud that the qui tam provisions of the False Claims Act allow individual whistleblowers to file suit against the wrongdoers and to share in any funds recovered.

Whistleblowers need to understand their rights under the False Claims Act. Waters & Kraus’ attorneys have the experience that a whistleblower needs on their side. Contact us or call our whistleblower attorneys at 800.226.9880 to learn more about our practice and how we can assist.