DOJ Announces $900 Million National Health Care Fraud Enforcement Action.

Date posted: July 6, 2016

The Department of Justice (DOJ) recently announced the largest Medicare Fraud Strike Force sweep to date, resulting in charges against 301 individuals for nearly $900 million in fraudulent billings.  Significantly, the Centers for Medicare & Medicaid Services (CMS) also exercised its suspension authority under the Affordable Care Act to halt payment to numerous providers.  Fraud schemes involved a range of health care sectors, including psychotherapy, physical and occupational therapy, home health, and durable medical equipment.  Further, over 60 defendants were charged with fraud relating to the Part D prescription drug benefit program, the fastest-growing component of Medicare.

Key highlights surrounding the DOJ takedown include the following:

  • Defendants included doctors, nurses, licensed medical professionals, and health care company owners;
  • Defendants committed various health care crimes, including conspiracy to commit health care fraud, Anti-Kickback Statute violations, money laundering, and aggravated identity theft;
  • Defendants allegedly submitted Medicare and Medicaid claims for treatments that were medically unnecessary and often never provided; and
  • Patient recruiters, Medicare beneficiaries, and other co-conspirators allegedly received cash kickbacks to supply providers with information needed to submit fraudulent bills.

Since its inception in 2007, the Medicare Fraud Strike Force has collectively charged over 2,900 defendants who have falsely billed Medicare for over $8.9 billion.

The DOJ Justice News article is available at:

https://www.justice.gov/opa/pr/national-health-care-fraud-takedown-results-charges-against-301-individuals-approximately-900.

United States Department of Justice.  “National Health Care Fraud Takedown Results in Charges against 301 Individuals for Approximately $900 Million in False Billing.”  Justice News.  22 Jun. 2016.

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