DOJ Health Care Fraud
Takedown - Targets $295M in False Medicare Claims
September 9, 2011
In Houston, two individuals were charged with Medicare fraud schemes
involving $62 million in false claims for home health care and durable
medical equipment. According to the indictment, one of the defendants
sold Medicare beneficiary information to 100 different Houston-area home
health care agencies, and the agencies used that information to bill
Medicare for services that were unnecessary or not even provided.
Executive Assistant Director Shawn Henry, left, is joined by Attorney
General Eric Holder and HHS Secretary Kathleen Sebelius in announcing a
nationwide Medicare fraud takedown operation.
But that’s just the tip of the enforcement iceberg: Attorney General
Eric Holder, FBI Executive Assistant Director Shawn Henry, and other
officials announced a nationwide takedown that took place over the past
week involving Medicare Fraud Strike Force operations in seven other
cities as well—Baton Rouge, Brooklyn, Chicago, Dallas, Detroit, Los
Angeles, and Miami. A total of 91 individuals were charged with various
Medicare fraud-related offenses, including fraudulent billings of
approximately $295 million, the largest amount in phony claims involved
in a single takedown in Strike Force history.
The Medicare Fraud Strike Force, coordinated jointly by the Department
of Justice (DOJ) and the Department of Health and Human Services (HHS),
is a multi-agency team of federal, state, and local investigators who
combat Medicare fraud by analyzing data about the problem and putting an
increased focus on community policing. The strike force is part of the
Health Care Fraud Prevention and Enforcement Action Team (HEAT), another
joint DOJ-HHS initiative that works to prevent and deter fraud…and
enforce current anti-fraud laws. The strike force currently operates in
nine U.S. cities (the eight cities mentioned previously, plus Tampa) in
areas victimized by high levels of health care fraud.
Other cases announced today include:
Miami, 45 individuals—including a doctor and a nurse—were charged for
their participation in various fraud schemes involving a total of $159
million in fraudulent Medicare billings in the areas of home health
care, mental health services, occupational and physical therapy, durable
medical equipment, and HIV infusion.
- In Los Angeles, six
defendants—including one doctor—were charged for their roles in schemes
to defraud Medicare of more than $10.7 million.
- In Brooklyn, three
defendants—including two doctors—were charged in a fraud scheme
involving more than $3.4 million in false claims for medically
unnecessary physical therapy.
- In Detroit, 18
additional defendants—including doctors, nurses, clinic operators, and
other health care professionals—were charged for schemes involving an
additional $28 million in false billing.
In addition to our
role on the Medicare Fraud Strike Force, the FBI also operates health
care fraud task forces or working groups in all 56 of our field offices.
Hundreds of agents and analysts—using intelligence to identify emerging
schemes and tactics—are currently working more than 2,600 health care
Nearly 70 percent of these cases involve government-sponsored programs,
like Medicare, since the Bureau is the primary investigative agency with
jurisdiction over federal insurance programs. But we also have primary
investigative jurisdiction over private insurance programs, and we work
closely with private insurers to address threats and fraud directed
towards these programs.
Taking part in this takedown were more than 400 law enforcement
personnel from the FBI, HHS-Office of Inspector General, multiple
Medicare fraud control units, and state and local law enforcement