Corporate Compliance

News: Feds nab 91 suspects in Medicare billing scheme totaling $295M

Compliance Monitor, September 14, 2011

Federal authorities September 7 detailed an eight-city sweep by the Medicare Fraud Strike Force that netted 91 suspects—including 11 physicians and two nurses – for various fraud schemes involving false billing.

The $295 million in false Medicare billings represents the largest single amount of fraud uncovered in a single investigation in the four-year history of the Strike Force. More than 400 investigators from the Department of Justice, FBI, Office of the Inspector General, and state and local law enforcement agencies took part in the raids, federal authorities said in a joint media release.

“Today’s arrests are a powerful warning to those who would try to defraud taxpayers and Medicare beneficiaries,” HHS Secretary Kathleen Sebelius said in the press release. “These arrests illustrate close cooperation between the Medicare program that identified these fraudsters and the law enforcement officials who acted swiftly to cut them off. And our efforts to stop criminals don’t end here because the Affordable Care Act gives us new tools to prevent Medicare fraud before it is committed – better protecting seniors and the integrity of the Medicare program for generations to come.”

Federal prosecutors detailed the allegations in each city:

In Miami, 45 people, including a physician and a nurse, were charged in various fraud schemes involving a total of $159 million in false billings for home healthcare, mental health services, occupational and physical therapy, durable medical equipmentDME, and HIV infusion services. In one case, 24 people are charged with participating in a community mental health center fraud scheme involving more than $50 million in fraudulent billing. The defendants allegedly paid patient recruiters to refer ineligible beneficiaries to the mental health center. In some instances, recruiters allegedly threatened beneficiaries who were residents of halfway houses with eviction if they did not attend the mental health center.

In Houston, two people were charged with fraud schemes involving $62 million in false billings for home health care and DME. One defendant allegedly sold beneficiary information to 100 different Houston-area home healthcare agencies in exchange for illegal payments. The indictment alleges that the home agencies then used the beneficiary information to bill Medicare for services that were unnecessary or never provided.

Read the full story on HealthLeaders Media.

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