FBI Arrests 243 Individuals for False Medicare Billing

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Summary: The largest Medicare fraud bust in history was carried out earlier this week.

According to FBI.gov, over 240 individuals have been arrested in connection to a Medicare fraud scheme that involves roughly $71 million in false billings. Doctors, nurses, and other medical professionals were included in the group.

  

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The arrests began on Tuesday. A coordinated operation in 17 different cities was initiated by Medicare Fraud Strike Force teams, which include individuals from the Department of Justice, the Department of Health and Human Services, the FBI, and local law enforcement. The Strike Force aims to fight healthcare abuse, fraud, and waste.

Last year, President Obama decided to make all Medicare payment information public.

According to statements made at a press conference on Thursday, the group of arrests is the largest health care fraud takedown in terms of financial value and the number of individuals arrested.

Attorney General Loretta Lynch said, “These are extraordinary figures. They billed for equipment that wasn’t provided, for care that wasn’t needed, and for services that weren’t rendered.”

The charges stem from a multitude of alleged fraud schemes that involved medical treatments and services. Court documents detail schemes that involved submitting claims to Medicare for treatments that were not necessary or not even provided. In many cases, beneficiaries and co-conspirators were paid kickbacks for providing beneficiary information so that the false claims could be submitted. Additionally, 44 defendants were involved in Medicare Part D schemes, which is the prescription drug benefit program. It is the fastest growing section of Medicare.

FBI Director James B. Comey said, “There is a lot of money there, so there are a lot of criminals.” Comey explained, “…in these case, we followed the money and found criminals who were attracted to doctors’ offices, clinics, hospitals, and nursing homes in search of what they viewed as an ATM.”

Last year, a Miami medical clinic owner was sentenced to 108 months for Medicare fraud.

Strike Force was created in 2007. Since that time, roughly, 2,300 individuals have been charged for falsely billing Medicare in excess of $7 billion. Over 200 doctors and 400 medical professionals have been prosecuted. The current arrests are the first time the Strike Force has been involved in a national takedown.

In one case, a defendant coached beneficiaries on what to tell doctors so that they would appear eligible for Medicare services. That defendant received over $4 million. In Los Angeles, one doctor pocketed $23 million, according to the Washington Post.

HHS Secretary Sylvia Mathews Burwell commented, “We will not stop here. We will work tirelessly to prevent these programs from becoming targets and fight fraud wherever we find it.”

U.S. Department of Health Inspector General Daniel Levinson added, “This record-setting takedown sends a message to would-be perpetrators that health care fraud is a risky way to line your pockets. 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,” according to Business Insider.

Doctors allegedly earn billions from drug companies.

Over 900 law enforcement officials took part in the arrests. In fiscal year 2014, healthcare fraud and prevention moves by the DOJ and HHS recovered over $15 billion. The average prison sentence was over 4 years, although some have received up to 50 years.

Source: FBI.gov

Photo credit: blogs.plos.org, CNBC (Lynch)