Friday, September 9, 2011
Thursday, September 8, 2011
Nebraska Joe Bruning Advocates Medicaid Fraud In Child Welfare
I posted this almost 4 years ago. In honor of Nebraska's Auditor General Report on posthumous payments, I have dedicated this piece on privatization to them.
Privatization can be fiscally responsible.
The Detroit News
This was published 10/31/07 06:09 PM
The Governor should embrace with joy the championing of privatization of foster care and adoption services by Senator Hardiman. This is what we all have been awaiting.
Privatizing foster care and adoption services releases the constraints of enforcement within the executive branch. The Attorney General is now able to flick the switch of the oversight machine and provide accountability for the state and its families. This is what is to happen:
The responsibility of contract monitoring and compliance is transferred from DHS back into the hands of the Attorney General. For example, families whose children have been removed where privatized agencies do not believe in family reunification, can now file complaints with the Attorney General regarding protection of consumer rights. The Bureau of Children and Family Services Fraud Division may now protect, not just vulnerable adults, but vulnerable children and families.
When the Attorney General conducts investigations and finds material violations of law and policy by the privatized child placing agencies, he is now allowed to follow through with full prosecution of the agencies and their workers.
In turn, families are provided proactive services, there are no longer phantom programs funded by DHS, tens of millions of dollars in improper payments of improper, unneccessary services and placements of children in foster care are ameliorated.
The number of children entering foster care are reduced because privatized child placing agencies must promote and advocate for placement of children within the family which is more cost effective than having a child prescribed psychiatric medication to "calm" from the trauma of being ripped from his/her home and placed in a strangers home, further reducing medicaid waste and fraud.
Privatized child placing agencies, under the theory of punishment by deterrence, will produce accurate and transparent audit reports, simply from the fear of prosecution.
Practices of targeting minority and impoverished children, due to the fact that child abuse and neglect is an entitlement program, will cease in the face of civil rights penalties.
Michigan will become a model state for accountability and transparency by reducing dependency of federal funding streams in Social Security. The money saved by privatized child placing agencies can be invested in education, thus, replacing the state's number one industry (Human Services) with higher education.
Michigan is no longer liable for litigation. The Executive Office is no longer a demagogue to privatized child placing agencies who also lobby (many without proper IRS status), but becomes the fiscal savior of our families.
Everyone wins...except the privatized child placing agencies that violate federal and state laws and policies, under color of state law.
Beverly Tran
Where the hell is the Attorney General?
Hey Joe, get off your lazy punk ass and get that Medicaid Fraud Control Unit up and do something. Damn. Just sad. Maybe you might want to keep screaming about too much regulation particularly the antifraud provisions in the Obamacare. Moron.
Seriously, listen to him. Here he is referring to welfare recipients as "raccoons". He has to know that when the families are cut off, the children go to foster care... wait, he does know what he is talking about. The privatized child placing agencies are making a killing on Medicaid fraud.
This is why his Medicaid Fraud Control Unit allows fraud to flourish in child welfare.
Patients Deserve to Know What Drug Companies Pay Their Doctor
Patients Deserve to Know What Drug Companies Pay Their Doctor
Your doctor gives you an expensive new drug to control your cholesterol, or recommends a certain brand of artificial hip, or says you need a stent to open a clogged artery.
He's the expert. But how do you know his expertise is untainted? The makers of the drug, the replacement hip or the stent may have paid your doctor to deliver promotional talks extolling the virtues of the product. Or they could be paying him, or her, to consult on marketing plans.
It doesn't necessarily follow, of course, that this kind of moonlighting influences the treatment you receive. And many doctors don't accept these kinds of payments. But if yours does, wouldn't you like to know that?
As it stands, doctors don't have to tell you if they're working with the makers of the products they're prescribing you. They don't have to tell you whether they own stock in those companies or do research on their behalf.
There's no place for you -- the patient -- to find out whether your doctor is prescribing more drugs or medical devices made by companies with whom he has a relationship.
Understanding such ties can be important. Many brand-name drugs are wildly expensive, and some carry an array of dangerous side effects. Sometimes similar drugs, either those made by competitors or generics, are cheaper or have fewer risks.
Patients largely trust their doctors to do what's right for them. But a recent string of scandals has raised questions about whether patients need to know more. Pharmaceutical and medical device makers have paid billions of dollars to settle accusations of kickbacks to doctors and improper marketing of their products.
Many physicians say the close ties between drug and device firms and doctors lead to new and more effective medications, life-saving innovations and a better-educated profession. Although this is certainly true, the relationships also can cause physicians to -- consciously or not -- downplay side effects and poor research outcomes, studies show.
Earlier this summer, for example, the Spine Journal devoted an entire issue to repudiating the research of several spine experts that supported the widespread use of a Medtronic bone growth product used in spinal fusions. The articles charged that the researchers, who had substantial financial ties to Medtronic, overstated the benefits of the product, Infuse, and ignored its risks.
Only recently have some tools become available to help patients learn about their doctors' financial ties before they are in the exam room.
Several companies, pressured by Congress or required by legal settlements, have started to reveal the names of the doctors they've paid to deliver promotional talks or serve as consultants.
By 2013, every drug and device company operating in the United States will have to do the same, under the health-care reform law passed last year. They'll also have to say if they've paid doctors for consulting, research, even a dinner.
We've looked at the data from 12 companies, which make up 40 percent of U.S. drug sales, and found some surprises among pharma's favored speakers and consultants.
Many of the doctors who received the most money hadn't published much in the way of research, and many didn't have associations with academic medical centers. Some had no credentials beyond a medical license. And some had been sanctioned for misconduct by their home state medical boards.
Among the top-paid speakers from that sampling was Santa Monica pain physician Gerald Sacks. Since 2009, he has earned at least $522,113 giving promotional talks and consulting for four companies, according to the data.
Sacks, an anesthesiologist, isn't a leader in prominent pain medicine societies, and several top pain physicians told us they hadn't heard of him. He doesn't work in an academic medical center such as UCLA or USC. He hasn't published much research. We tried to talk to him about what he was paid for, but he didn't return numerous messages.
Sacks' slides from a 2008 educational talk and 2009 presentation before the U.S. Food and Drug Administration describe him as the director of pain management at St. John's Health Center in Santa Monica. A hospital spokesman said Sacks has never held that title and that his pain clinic is not part of the hospital. He does have the ability to admit and treat patients at St. John's.
Drug firms have a pretty fair idea of whether their investment in doctors like Sacks pays off. They pay millions to researchers who buy data from pharmacies and track the prescribing habits of doctors. Pfizer, which gave Sacks at least $318,250 for speaking in 2009 and 2010, according to its data, could find out if and how often he gave patients Lyrica and Celebrex, two of the company's pain medications. Firms can also track whether and how often the people who attended such talks prescribed the drugs that were discussed.
But not everyone who would like to examine the data is allowed to. The middlemen who collect this information refused to sell the data to us.
That leaves it up to patients. ProPublica has created a database, Dollars for Docs, which allows you to check whether your doctor is being paid by any of the 12 companies currently disclosing this information.
Because all companies won't reveal their payments until 2013, you might also want to ask your doctor directly about them. It's worth inquiring whether cheaper versions are available, perhaps older or generic drugs. Does the drug have more side effects than competitors' drugs? In some situations, it might be worth asking whether non-drug solutions should be tried first.
Of course, checking the rolls of paid promotional speakers is just one consideration when picking or assessing your doctor. You can also look at your state's medical board website to see if a doctor has been disciplined or criminally convicted. You can talk to other patients about the thoroughness of the doctor's exams and openness to questions.
If you have a smartphone, you can access our database from anywhere -- even while sitting in your doctor's waiting room.
California Medical Billing Company Agrees to Pay U.S. $4.6 Million to Resolve Allegations of False Claims to Federal Health Care Programs
California Medical Billing Company Agrees to Pay U.S. $4.6 Million to Resolve Allegations of False Claims to Federal Health Care Programs
WASHINGTON – Janzen, Johnston & Rockwell Emergency Medicine Management Services Inc. (JJ&R), a provider of billing services for physicians, hospitals and other health care providers, has agreed to pay the United States $4.6 million to settle allegations that it submitted false claims to Medicare and Louisiana’s Medicaid program, the Justice Department announced today. JJ&R is headquartered in El Segundo, Calif.
Today’s settlement resolves allegations that JJ&R inflated claims that it had coded on behalf of emergency room physicians in Louisiana and California. From approximately 2000 through 2007, JJ&R utilized a coding formula that had a tendency to generate claims for a marginally higher level of evaluation and management service than the physicians had actually provided. In addition, JJ&R routinely added charges to the evaluation and management claim for minor services, such as pulse oximetry, that had been provided by hospital nursing staff or other physicians.
Finally, during this time period, JJ&R often failed to comply with Medicare’s coding rules governing the submission of claims for teaching physicians, resulting in the submission of claims that were not properly payable. While these coding practices had a relatively small impact on the reimbursement of any particular claim, over time they generated significant overpayments from Medicare and Medicaid.
“Inflating individual health care claims by even small amounts can cause significant losses to Medicare and Medicaid,” said Tony West, Assistant Attorney General for the Civil Division of the Department of Justice. “Taxpayers should not be on the hook for charges that shouldn’t have been added or claims that shouldn’t have been submitted.”
“ In Louisiana’s Middle District we are committed to using all available tools, including affirmative civil actions, to combat health care fraud,” said Donald J. Cazayoux Jr., U.S. Attorney for the Middle District of Alabama.
“The Office of the Inspector General recognizes and appreciates the importance of whistleblowers in the fight against health care fraud,” said William W. Root, Assistant Special Agent-in-Charge for the U.S. Department of Health and Human Services (HHS).
Today’s settlement resolves allegations that were the subject of a federal investigation and a lawsuit brought by Le Jeanne Harris, a former employee of JJ&R. The lawsuit was filed under the False Claims Act, which enables private persons to sue on behalf of the United States, and to receive a share of any recovery. In this case, Ms. Harris will receive $774,450.
This matter was handled by the U.S. Attorney’s Office for the Middle District of Louisiana, as well as HHS Office of the Inspector General (OIG) and the Commercial Litigation Branch - Fraud Section of the Justice Department’s Civil Division. HHS-OIG investigated the matter.
45 INDIVIDUALS AND ONE CORPORATION CHARGED AS PART OF NATIONWIDE OPERATION BY HEALTH CARE FRAUD PREVENTION AND ENFORCEMENT ACTION TEAMS (HEAT)
45 INDIVIDUALS AND ONE CORPORATION CHARGED AS PART OF NATIONWIDE OPERATION BY HEALTH CARE FRAUD PREVENTION AND ENFORCEMENT ACTION TEAMS (HEAT)
September 7, 2011
FOR IMMEDIATE RELEASE
91 Defendants Charged Nationally for Submitting More than $295 Million in Fraudulent Billing
Wifredo A. Ferrer, United States Attorney for the Southern District of Florida, John V. Gillies, Special Agent in Charge, Federal Bureau of Investigation (FBI), Miami Field Office, and Christopher Dennis, Special Agent in Charge, U.S. Department of Health and Human Services, Office of Inspector General (HHS-OIG), announced charges against forty-five (45) individuals and one corporation as part of a nationwide enforcement operation by HEAT Task Force Teams. The 46 South Florida defendants are allegedly responsible for more than $160 million in false billings to Medicare.
In addition, as part of a coordinated national HEAT health care fraud takedown, the Department of Justice announced that 45 additional defendants were charged by HEAT teams in other cities, including Detroit, Los Angeles, Brooklyn, Houston, Dallas, Chicago, and Baton Rouge. Collectively, the 91 defendants, including doctors, nurses, medical professionals, health care company owners and others charged in the indictments and complaints, are accused of conspiring to submit a total of more than $295 million in fraudulent billing.
The joint Department of Justice-HHS Medicare Fraud Strike Force is a multi-agency team of federal, state and local investigators designed to combat Medicare fraud through the use of Medicare data analysis techniques and an increased focus on community policing. Over the course of the past week, approximately 400 law enforcement agents from the FBI, HHS-Office of Inspector General (HHS-OIG), multiple Medicaid Fraud Control Units, and other state and local law enforcement agencies participated in the takedown. In addition to making arrests, agents also executed 18 search warrants in connection with ongoing strike force investigations.
U.S. Attorney Wifredo A. Ferrer stated, “The South Florida defendants, including clinic owners, a doctor, a nurse, mental health and family counselors, and patient recruiters, engaged in more than $160 million in Medicare fraud. In a new twist to the ever-changing Medicare fraud schemes, some of the defendants went as far as to recruit vulnerable out of state Medicare patients who were down on their luck or suffering from drug or alcohol addiction. The defendants promised the patients a roof over their heads in halfway houses as long as they received community mental health services that they did not need. If the patients refused the treatments, they were threatened with eviction and thrown out on the street. This conduct is outrageous and will not be tolerated. We will continue to fight the battle against health care fraud on all fronts, whether in community mental health care, home health care, HIV-infusion therapy, and durable medical equipment fraud.”
“The defendants charged in this takedown are accused of stealing precious taxpayer resources and defrauding Medicare - jeopardizing the integrity of our health care system and our nation’s most critical health care program for personal gain,” said Attorney General Holder. “Our highly coordinated, nationwide Strike Force operations are working aggressively to combat Medicare fraud and our anti-health care fraud efforts have never been more innovative, collaborative, aggressive - or effective. We will continue to work with our law enforcement partners and partners across government to fight against health care fraud.”
“South Florida is ground zero for health care fraud. The FBI and its partners devote vast resources to investigate, catch and prosecute those committing health care fraud,” said John V. Gillies, Special Agent in Charge of the FBI’s Miami Office. “To attack the problem from both ends, tougher regulation and oversight are key to reducing the amount of fraud in the first place.”
HHS-OIG Special Agent in Charge Christopher B. Dennis stated, “These 45 indicted individuals are representative of the OIG’s commitment to root out Medicare fraud in South Florida. The OIG will continue to identify, locate, and charge those responsible for stealing from the Medicare trust fund and ultimately the American taxpayer.”
The South Florida cases announced as part of the nationwide HEAT Enforcement Operation include:
United States v. Antonio Macli, et al.
United States v. Rufus Cargile
United States v. John Jackson
United States v. Sabrina Pressley
United States v. Rufus Cargile
United States v. John Jackson
United States v. Sabrina Pressley
In these four separate cases, a total of twenty-three (23) individual defendants and one corporation (Biscayne Milieu) are charged with conspiracy to commit health care fraud, health care fraud, conspiracy to pay and receive health care kickbacks, payment and receipt of health care kickbacks, conspiracy to launder money, and money laundering in connection with the operation of Biscayne Milieu Health Center, Inc. (Biscayne Milieu), a community mental health center. According to the charges, Biscayne Milieu purported to provide a partial hospitalization program (PHP) for Medicare beneficiaries suffering from mental illnesses. In fact, however, the defendants devised a scheme in which they paid patient recruiters and even doctors to refer ineligible Medicare beneficiaries to Biscayne Milieu for purported PHP services. Indeed, some of the patients admitted to Biscayne Milieu were not eligible for PHP because they suffered from severe dementia or Alzheimer’s disease and would not benefit from group therapy. The indictment alleges that from January 2007 to June 2011, Biscayne Milieu submitted more than $50 million in fraudulent claims. This case is being prosecuted by Assistant U.S. Attorney Alicia Shick.
United States v. Ramchand Ramrup
United States v. Joseph B. Williams, et. al.
United States v. Robert Jenkins, et. al.
United States v. Robert Revels, et. al.
United States v. Barry Nash
United States v. Isabel Roque
United States v. Irene Trematerra
United States v. Joseph B. Williams, et. al.
United States v. Robert Jenkins, et. al.
United States v. Robert Revels, et. al.
United States v. Barry Nash
United States v. Isabel Roque
United States v. Irene Trematerra
In this group of cases, ten (10) defendants were charged with conspiracy to commit health care fraud, conspiracy to receive and pay health care kickbacks, and receipt of health care kickbacks. According to court documents, from 2005 through 2010, the defendants variously participated in a fraudulent scheme orchestrated by the owners and operators of American Therapeutic Corporation (ATC) and its management company, Medlink Professional Management Group Inc. (Medlink). ATC purportedly provided partial hospitalization programs (PHPs) in seven different locations throughout South Florida and Orlando. ATC’s owners and operators purportedly paid kickbacks to owners and operators of assisted living facilities, including, for example, Boynton Beach Assisted Living Facility, in Boynton Beach, and Avondale Manor Retirement Home, in Pompano Beach, and halfway houses and to other patient recruiters. In exchange, the defendants delivered ineligible Medicare beneficiaries to ATC. Throughout the course of the fraudulent scheme, ATC billed Medicare more than $200 million for the medically unnecessary services and for services that were never provided. These cases are being prosecuted by Acting Assistant Chief Benjamin Singer and Trial Attorneys Steven Kim and Jennifer Saulino of the Department of Justice, Criminal Division, Fraud Section.
United States v. Marietha Morales, et. al.
United States v. Ariel Rodriguez, et al.
United States v. Roberto Gonzalez, et. al.
United States v. Ariel Rodriguez, et al.
United States v. Roberto Gonzalez, et. al.
In these related cases, nine (9) defendants were charged with conspiracy to commit health care fraud and conspiracy to pay health care kickbacks. According to the charges, the defendants owned and operated home health care agencies that purported to provide home health care to homebound Medicare beneficiaries who were insulin-dependent but could not self-medicate. In fact, however, the defendants paid kickbacks to patient recruiters, who referred ineligible beneficiaries to the defendants’ home health companies. The defendants obtained fraudulent prescriptions and other medical documentation ordering home health services for the beneficiaries and falsified documentation indicating that the services had been provided. In fact, the beneficiaries did not require or receive home health services.
In this way, three home health companies owned and operated by the defendants billed Medicare for more than $100 million. More specifically, Prime Home Health, operated by defendants Marietha Morales and Eduardo Dominguez, submitted approximately $22 million in false Medicare claims for services purportedly provided to approximately 500 beneficiaries from April 2007 through April 2011. Serendipity Home Health, operated by defendants Ariel Rodriguez, Reynaldo Navarro, Melissa Rodriguez and Ysel Salado, submitted approximately $21 million in false Medicare claims for services purportedly provided to approximately 519 beneficiaries from April 2007 through March 2009. Nany Home Health, operated by defendants Roberto Gonzalez, Olga Gonzalez, and Fabian Gonzalez, submitted approximately $60 million in false Medicare claims for services purportedly provided to approximately 1474 beneficiaries from January 2006 through November 2009. These cases are being prosecuted by Trial Attorney Joseph S. Beemsterboer of the Department of Justice, Criminal Division, Fraud Section.
United States v. Maratib Hashmi
Maratib Hashmi, of Miami, Florida, is charged with conspiracy to commit health care fraud, health care fraud, and money laundering. According to the indictment, Hashmi operated L’Image Physical Therapy and Rehabilitation, Inc., a Miami-Dade medical clinic that purportedly provided physical and occupational therapy to Medicare beneficiaries. From September 2009 through March 2010, Hashmi submitted approximately $1.2 million in false Medicare claims for outpatient physical and occupational therapy purportedly provided by L’Image. This case is being prosecuted by Assistant U.S. Attorney Adam Schwartz.
United States v. Clara Luz Varona
Clara Luz Varona, of Miami, is charged with conspiracy to commit health care fraud and health care fraud. According to the indictment, Varona co-owned A&C Medical Supplies Inc., a Miami-Dade durable medical equipment company that purportedly provided medical supplies to Medicare beneficiaries. The indictment alleges that between January 2005 and July 2009, Varona submitted false Medicare claims for approximately $1.8 million in medical supplies purportedly provided by A&C. Based on these claims, Medicare paid A&C approximately $1.1 million. This case is being prosecuted by Assistant U.S. Attorney Jon Juenger.
United States v. Oscar Hernandez
Oscar Hernandez, of Miami, is charged with conspiracy to commit money laundering. According to the Information, from May 2009 to June 2009, Hernandez assisted the owners of two fraudulent durable medical equipment companies by laundering $316,750 in Medicare fraud proceeds by cashing corporate checks made out to phony shell corporations. Hernandez received a percentage of the cashed checks as his fee. This case is being prosecuted by Assistant U.S. Attorney Chris Clark.
United States v. Reina Addis Masson
Reina Addis Masson, of Hialeah Gardens, is charged with conspiracy to commit health care fraud, health care fraud, conspiracy to receive and pay health care kickbacks, and receipt of health care kickbacks. The indictment alleges that Masson worked at A’s Medical Center (“AMC”), a medical clinic that purported to treat HIV positive Medicare beneficiaries. From October 2005 to December 2006, AMC submitted approximately $4.1 million in false claims for treatment of HIV therapy. Based on these claims, Medicare paid AMC approximately $700,000. At various times, Masson worked as a medical assistant, a patient recruiter, and a biller for AMC. This case is being prosecuted by Economic Crimes Deputy Chief Marc Osborne.
The Medicare Fraud Strike Force operations are part of the Health Care Fraud Prevention & Enforcement Action Team (HEAT), a joint initiative announced in May 2009 between the Department of Justice and HHS to focus their efforts to prevent and deter fraud and enforce current anti-fraud laws around the country. Since their inception in March 2007, Strike Force operations in nine locations have charged more than 1,140 defendants who collectively have falsely billed the Medicare program for more than $2.9 billion. In addition, the HHS Centers for Medicare and Medicaid Services, working in conjunction with the HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.
Mr. Ferrer commended the investigative efforts of the FBI and HHS-OIG.
An indictment or information is merely a charge and defendants are presumed innocent until proven guilty.
Anyone with information regarding their whereabouts should call the FBI in Miami at (305) 944-9101.
A copy of this press release may be found on the website of the United States Attorney's Office for the Southern District of Florida at http://www.usdoj.gov/usao/fls. Related court documents and information may be found on the website of the District Court for the Southern District of Florida at http://www.flsd.uscourts.gov or onhttp://pacer.flsd.uscourts.gov.
Technical comments about this website can be e-mailed to the Webmaster. PLEASE NOTE: The United States Attorney's Office does not respond to non-technical inquiries made to this website. If you wish to make a request for information, you may contact our office at 305-961-9001, or you may send a written inquiry to the United States Attorney's Office, Southern District of Florida, 99 NE 4th Street, Miami, Fl. 33132.
Operator Of Defunct Medical Labs Sentenced In Medicaid Fraud Scheme
The former operator of medical laboratories in East Hartford and West Hartford was sentenced today to serve two years in prison and ordered to pay $20,000 restitution for billing the government for lab tests and other services that were never provided.
TAHIR SAEED SHERANI, age 46, formerly of South Orange, New Jersey, was sentenced in Hartford Superior Court, G.A. No. 14, by the Honorable Judge Elpedio N. Vitale to two years imprisonment and ordered to pay $20,000 restitution.
Mr. Sherani pled guilty in July to one count of Larceny in the First Degree By Defrauding A Public Community and one count of Attempted Larceny in the First Degree By Defrauding A Public Community, both class B felonies.
Mr. Sherani operated American Diagnostic Laboratories, Inc., in East Hartford and Immediate Medical Care, Inc., in West Hartford, until the businesses were shut down by federal and state authorities in 2003. Mr. Sherani subsequently moved to California, where he was convicted in 2005 of defrauding that state's Medicaid program.
In 2010 Mr. Sherani was returned to Connecticut to face charges involving more than 3,800 false claims for Medicaid reimbursement for services that were never provided. Medicaid is a government-funded health care program that serves low-income individuals.
The case was prosecuted by the Medicaid Fraud Control Unit in the Chief State's Attorney's Office. The unit is grateful for the assistance it received in this investigation from the State of Connecticut Department of Social Services Office of Quality Assurance, the Federal Bureau of Investigation, the Office of the Inspector General of the U.S. Department of Health and Human Services and the West Hartford and Windsor Locks Police Departments.
Medicare Fraud Strike Force Charges 91 Individuals for Approximately $295 Million in False Billing
Medicare Fraud Strike Force Charges 91 Individuals for Approximately $295 Million in False Billing
U.S. Department of JusticeSeptember 07, 2011 |
WASHINGTON—Attorney General Eric Holder and Health and Human Services (HHS) Secretary Kathleen Sebelius announced today that a nationwide takedown by Medicare Fraud Strike Force operations in eight cities has resulted in charges against 91 defendants, including doctors, nurses, and other medical professionals, for their alleged participation in Medicare fraud schemes involving approximately $295 million in false billing.
Attorney General Holder and Secretary Sebelius were joined in the announcement by FBI Executive Assistant Director Shawn Henry, Assistant Attorney General Lanny A. Breuer of the Justice Department’s Criminal Division, and HHS Inspector General Daniel R. Levinson.
As part of a coordinated action, 70 individuals were charged by Strike Force prosecutors in indictments unsealed yesterday and today in six cities alleging a variety of Medicare fraud schemes involving approximately $263.6 million in false billings. As part of takedown operations last week, 18 additional defendants were charged in Detroit and one defendant was charged in Miami in cases unsealed on Sept. 1, 2011, for their alleged roles in Medicare fraud schemes involving approximately $29.4 million in fraudulent claims. Additionally, two individuals are scheduled to appear in court today on charges filed on Aug. 24, 2011, for their roles in a separate $2 million health care fraud scheme. This coordinated takedown involved the highest amount of false Medicare billings in a single takedown in Strike Force history.
The joint Department of Justice-HHS Medicare Fraud Strike Force is a multi-agency team of federal, state, and local investigators designed to combat Medicare fraud through the use of Medicare data analysis techniques and an increased focus on community policing. Over the course of the past week, approximately 400 law enforcement agents from the FBI, HHS-Office of Inspector General (HHS-OIG), multiple Medicaid Fraud Control Units, and other state and local law enforcement agencies participated in the takedown. In addition to making arrests, agents also executed 18 search warrants in connection with ongoing strike force investigations.
“The defendants charged in this takedown are accused of stealing precious taxpayer resources and defrauding Medicare – jeopardizing the integrity of our health care system and our nation’s most critical health care program for personal gain,” said Attorney General Holder. “Our highly coordinated, nationwide Strike Force operations are working aggressively to combat Medicare fraud and our anti-health care fraud efforts have never been more innovative, collaborative, aggressive – or effective. We will continue to work with our law enforcement partners and partners across government to fight against health care fraud.”
“Today’s arrests are a powerful warning to those who would try to defraud taxpayers and Medicare beneficiaries,” said HHS Secretary Sebelius. “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.”
The defendants charged are accused of various health care fraud-related crimes, including conspiracy to defraud the Medicare program, health care fraud, violations of the anti-kickback statutes and money laundering. The charges are based on a variety of alleged fraud schemes involving various medical treatments and services such as home health care, physical and occupational therapy, mental health services, psychotherapy, and durable medical equipment (DME).
According to court documents, the defendants allegedly participated in schemes to submit claims to Medicare for treatments that were medically unnecessary and oftentimes never provided. In many cases, indictments and complaints allege that patient recruiters, Medicare beneficiaries and other co-conspirators were paid cash kickbacks in return for supplying beneficiary information to providers, so that the providers could submit fraudulent billing to Medicare for services that were medically unnecessary or never provided. Collectively, the doctors, nurses, medical professionals, health care company owners and others charged in the indictments and complaints are accused of conspiring to submit a total of approximately $295 million in fraudulent billing.
“The health care system is part of our nation’s infrastructure and we must do everything in our power to protect the integrity of Medicare and the system at large,” said FBI Executive Assistant Director Henry. “Working together as partners, we can stop criminals who seek to steal American taxpayers’ hard-earned dollars and we help ensure our nation’s health care system is there for those who need it.”
“As charged in these indictments, the defendants cover nearly the entire spectrum of health care providers, and perpetrated a variety of fraudulent schemes,” said Assistant Attorney General Breuer. “From Brooklyn to Miami to Los Angeles, the defendants allegedly treated the Medicare program like a personal piggy bank. Today’s Strike Force operations should serve as a wake-up call to would-be fraudsters nationwide. With Strike Force teams now in nine cities across the country, and employing sophisticated, data-driven law enforcement methods, we are determined to hold criminally responsible those who defraud Medicare.”
“The warning should be unambiguously clear by now,” said HHS Inspector General Levinson. “We will continue using the combined law enforcement might of Strike Forces around the country to combat health care fraud.”
In Miami, 45 defendants, including one doctor and one nurse, were charged today and yesterday for their participation in various fraud schemes involving a total of $159 million in false billings for home health care, mental health services, occupational and physical therapy, DME, and HIV infusion. Another defendant in Miami was charged on Sept. 1, 2011, for a $1 million Medicare fraud scheme. In one case, 24 defendants are charged for participating in a community mental health center fraud scheme involving more than $50 million in fraudulent billing. According to court documents, the defendants allegedly paid patient recruiters to refer ineligible beneficiaries to the mental health center. In some instances, beneficiaries who were residents of halfway houses were allegedly threatened with eviction if they did not agree to attend the mental health center.
This is done everyday in foster care. If an original parent does "not agree to attend the mental health center", their parental rights shall be terminated. The children in foster care have no choice. They are automatically sent to mental health services, well, at least on paper they are.
Same fraud scheme. Different age population.
In Houston, two individuals were charged today with fraud schemes involving $62 million in false billings for home health care and DME. According to an indictment, one defendant allegedly sold beneficiary information to 100 different Houston-area home health care 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.
Ten defendants were charged in Baton Rouge, La., for participating in schemes involving more than $24 million related to false claims for home health care and DME. According to one indictment, a doctor, nurse, and five other co-conspirators participated in a scheme to bill Medicare for more than $19 million in skilled nursing and other home health services that were medically unnecessary or never provided.
Six defendants, including two doctors, were charged in Los Angeles for their roles in schemes to defraud Medicare of more than $10.7 million. In Brooklyn, three defendants, including two doctors, were charged for a fraud scheme involving more than $3.4 million in false claims for medically unnecessary physical therapy. Two defendants, including a doctor, are making initial appearances today in U.S. federal court in Dallas after being charged for a scheme to defraud Medicare of approximately $2.1 million.
In Detroit, 18 defendants, including three doctors, were charged last week for schemes to defraud Medicare of more than $28 million. According to an indictment, 14 of the defendants participated in a home health care scheme that submitted more than $14 million in false claims to Medicare.
Finally, four defendants including one doctor, were charged in Chicago for their alleged roles in schemes to defraud Medicare of more than $4.4 million.
The Medicare Fraud Strike Force operations are part of the Health Care Fraud Prevention & Enforcement Action Team (HEAT), a joint initiative announced in May 2009 between the Department of Justice and HHS to focus their efforts to prevent and deter fraud and enforce current anti-fraud laws around the country.
Since their inception in March 2007, Strike Force operations in nine locations have charged more than 1,140 defendants who collectively have falsely billed the Medicare program for more than $2.9 billion. In addition, the HHS Centers for Medicare and Medicaid Services, working in conjunction with the HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.
The cases announced today are being prosecuted and investigated by Medicare Fraud Strike Force teams comprised of attorneys from the Fraud Section of the Justice Department’s Criminal Division and from the U.S. Attorney’s Offices for the Southern District of Florida, the Eastern District of Michigan, the Eastern District of New York, the Southern District of Texas, the Central District of California, the Middle District of Louisiana; the Northern District of Illinois, and the Northern District of Texas; and agents from the FBI, HHS-OIG, and state Medicaid Fraud Control Units.
An indictment is merely a charge and defendants are presumed innocent until proven guilty.
To learn more about the Health Care Fraud Prevention and Enforcement Action Team (HEAT), go to: www.stopmedicarefraud.gov.
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