Medicare fraud investigation nets 91 offenders

A nationwide sweep on lawbreakers has charged 91 people - including doctors and other medical professionals - with participating in Medicare fraud schemes involving $295 million in false billing.

Attorney General Eric Holder and Health and Human Services Secretary Kathleen Sebelius said Wednesday that 70 people were charged in indictments unsealed Tuesday and Wednesday and 21 others were charged earlier, beginning Aug. 24. Charges were filed in Baton Rouge, La.; Brooklyn, N.Y.; Chicago, Dallas, Detroit, Houston; Los Angeles and Miami.

The attorney general spoke at a news conference adding that those arrested are “jeopardizing the integrity of our health care system.” Sebelius called the law enforcement initiative “a powerful warning to those who would try to defraud taxpayers and Medicare beneficiaries.”

Eleven of the people charged were doctors, three were nurses and 10 were licensed health professionals. Over half the defendants — 46 — and $160 million of the total in phony claims announced Wednesday came from South Florida, still leading the nation in Medicare fraud.

“From Brooklyn to Miami to Los Angeles, the defendants allegedly treated the Medicare program like a personal piggy bank,” the head of the Justice Department's criminal division, Lanny Breuer said. The anti-fraud sweep over the last two weeks involved some 400 law enforcement agents from the FBI, HHS-Office of the Inspector General, multiple Medicaid Fraud Control Units, and other state and local law enforcement agencies. Officials said the operations took place in Miami, Houston, Baton Rouge, Los Angeles, Detroit, Dallas, New York and Chicago.

The Miami defendants alone were accused of participation in fraud schemes involving a total of nearly $160 million in false billings for home and mental health services, occupational and physical therapy, HIV infusion, and other services. “South Florida remains ground zero for healthcare fraud,” John V. Gillies, special agent in charge of the FBI's Miami division, told reporters in Miami.

Despite what he and others touted as the success of the latest crackdown on healthcare fraud, Gillies said he saw no end to the Medicare fraud problem any time soon. “We have dozens and dozens of cases to go,” said Gillies, referring to a fraud that the FBI has estimated to cost U.S. taxpayers anywhere between $70 billion and $234 billion a year. “I don't have all the resources I need. I don't believe the IG's Office (Office of Inspector General) has all the resources that they need,” Gillies said, when asked about the money and manpower needed to fight one of America's top crime problems. He said south Florida was also No. 1 in mortgage fraud and No. 2 in securities fraud, and has significant gang problems.

Dr. Ananya Mandal

Written by

Dr. Ananya Mandal

Dr. Ananya Mandal is a doctor by profession, lecturer by vocation and a medical writer by passion. She specialized in Clinical Pharmacology after her bachelor's (MBBS). For her, health communication is not just writing complicated reviews for professionals but making medical knowledge understandable and available to the general public as well.


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