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.

FBI 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:

• In 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 fraud investigations.

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 agencies.