Federal strike force discovers $251 million in Medicare fraud

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WASHINGTON, D.C.-Ninety-four people across several states have been charged for their alleged participation in schemes to collectively submit $251 million in false claims to the Medicare program.

Investigations by the Medicare Fraud Strike Force resulted in charges and arrests that occurred in Miami; Baton Rouge, La.; Brooklyn, N.Y.; Detroit; and Houston. The operation is the largest federal healthcare fraud takedown since Medicare Fraud Strike Force operations began in 2007.

The strike force is a joint Department of Justice/Department of Health and Human Services (HHS) team of federal, state, and local investigators designed to combat Medicare fraud through the use of Medicare data analysis techniques and an increased focus on community policing. More than 360 law enforcement agents participated in this particular operation.

“[W]e’re putting would-be criminals on notice: Healthcare fraud is no longer a safe bet,” said Attorney General Eric Holder in a statement. “The federal government is working aggressively-and collaboratively-to pursue healthcare criminals around the country and to bring these offenders to justice.”

Charges against the 94 individuals included conspiracy to defraud the Medicare program, criminal false claims, violations of the anti-kickback statutes, and money laundering. The charges are based on a variety of fraud schemes, including physical therapy and occupational therapy schemes, home healthcare schemes, HIV infusion fraud schemes, and durable medical equipment schemes.


‖ The Centers for Medicare & Medicaid Services announced nursing home payment rates for FY 2011 will be raised 1.7%, resulting in a $542 million increase ‖ Nursing home residents kept physically restrained declined from 11% in 1999 to 5% in 2007, according to the Agency for Healthcare Research and Quality ‖

According to the court documents, those who were charged participated in schemes to submit claims to Medicare for treatments that were medically unnecessary and, oftentimes, never provided. In many cases, indictments and complaints allege that beneficiaries accepted cash kickbacks in return for allowing providers to submit forms saying they had received the treatments. Doctors, healthcare company owners, executives, and others were charged in the indictments.

In Miami alone, 24 defendants were charged for allegedly participating in various fraud schemes that led to approximately $103 million in false billings.

The strike force operations are part of the Health Care Fraud Prevention & Enforcement Action Team (HEAT), a joint initiative announced in May 2009 between the Department of Justice and HHS to focus their efforts to prevent and deter fraud and enforce current anti-fraud laws around the country.

“The days of scamming dollars from our healthcare system are over,” HHS Secretary Kathleen Sebelius said during a regional healthcare fraud prevention summit on July 16 in Miami. “Thanks to new tools contained in the Affordable Care Act, we are more prepared than ever to safeguard taxpayer dollars and ensure that the healthcare coverage of our seniors, families, and children is secure.”

Through the Affordable Care Act, $350 million will be provided over the next 10 years to combat healthcare fraud. In addition, the law toughens sentencing for criminal activity, enhances screenings and enrollment requirements, encourages increased sharing of data across government, expands overpayment recovery efforts, and provides greater oversight of private insurance abuses, according to an HHS release.

Fourth Quarter Absorption in 31 Largest Metro Markets

The data shown above represents absorption for all Independent Living, Assisted Living and Nursing Care Properties within the 31 largest metro markets. Absoprtion represents the change in the number of occupied units/beds in the current quarter compared with the number occupied in the previous quarter. Long-Term Living 2010 August;59(8):10

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