Home Health & Hospice

Medicare fraud strike charges 243 healthcare providers for more than $700 million in false billing

Homecare Insider, June 22, 2015

Last week, the Department of Health and Human Services (HHS) announced an historic sweep that resulted in charges against 243 healthcare professionals across the country and care continuum for their alleged participation in Medicare fraud schemes involving approximately $712 million in false billings—a takedown encompassing an unprecedented number of defendants and government financial losses.

Those implicated in the raid, which was spearheaded by the Medicare Fraud Strike Force, span 17 districts, as well as a variety of settings (including home health), and licensed medical professions. In addition to contending with legal charges from HHS, a number of these providers have been suspended by CMS. 
Defendants are thought to have participated in schemes to submit claims to Medicare and Medicaid for treatments that were medically unnecessary and often never provided. Specific charges include conspiracy to commit healthcare fraud, violations of the anti-kickback statutes, money laundering, and aggravated identity theft. 
“The people charged in this case targeted the system each of us depends on in our most vulnerable moments,” said FBI Director James Comey in an HHS statement. “Health care fraud is a crime that hurts all of us and each dollar taken from programs that help the sick and the suffering is one dollar too many.”
In the statement, other government officials warned prospective fraudsters against committing Medicare abuse by pointing to the government’s ever-improving ability to detect and crack down on fraud through methods like enhanced screening and enrollment requirements, real-time billing analysis, predictive modeling technology, speedier investigations, and harsher sentences for convicted criminals.
“Today’s takedown includes perpetrators of prescription drug fraud, home health care fraud, and personal care services fraud, three particularly harmful types of fraud plaguing our health care system. This record-setting takedown sends a message to would-be perpetrators that health care fraud is a risky way to line your pockets,” said Inspector General Daniel R. Levinson in the statement. “Our agents and our law enforcement partners stand ready to protect these vital programs and ensure that those who would steal from federal health care programs ultimately pay for their crimes.”
Including last week’s enforcement actions, nearly 900 individuals have been charged in national takedown operations, which have involved more than $2.5 billion in fraudulent billings. 
The Medicare Fraud Strike Force is part of the Health Care Fraud Prevention & Enforcement Action Team (HEAT), a joint initiative between the Department of Justice and HHS to promote proper billing practices and enforce anti-fraud laws. 
To read HHS’ full announcement on the recent takedown, click here.