Largest Medicare fraud case in DOJ history alleges $712M in false billings

On June 18, the federal government charged 243 individuals with participating in a Medicare fraud scheme totaling approximately $712 million in false billings. The Medicare Fraud Strike Force, a joint initiative between the Department of Justice (DOJ) and Department of Health and Human Services, led the investigation.

“This is the largest takedown in the strike force’s eight-year history,” Attorney General Loretta Lynch said at a news conference in Washington, D.C. “It is the largest criminal healthcare fraud takedown in the Department of Justice.”

The alleged crimes took place in 17 districts and involved 46 doctors, nurses and other licensed medical professionals, according to a news release. The schemes included home healthcare, psychotherapy, physical and occupational therapy, durable medical equipment and pharmacy fraud.

Nearly 50 defendants were charged with Medicare Part D fraud, according to Lynch. She said an owner of a healthcare provider in south Florida allegedly received $1.6 million from Medicare Part D for prescriptions that were never purchased or dispensed. Another defendant allegedly prescribed unnecessary narcotic pain medications in exchange for patients’ identification information to make false billings.

The individuals were charged with submitting claims to Medicare and Medicaid for medically unnecessary treatments that were often never provided, according to the news release.

“They are accused of an array of serious crimes ranging from conspiracy to commit healthcare fraud to wire fraud to money laundering,” Lynch said. “They billed for equipment that wasn’t provided, for care that wasn’t needed and for services that were not rendered.”

The Medicare Fraud Strike Force, which began in 2007, has teams in nine locations: Miami; Los Angeles; Detroit; southern Texas; Brooklyn, New York; southern Louisiana; Tampa, Fla.; Chicago; and Dallas. Since its inception, it has charged more than 2,300 individuals with falsely billing more than $7 billion.