DOJ sets new Medicare fraud case record with $900M sweep

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In what the Department of Justice (DOJ) is calling the “largest takedown ever” of Medicare fraud, 301 people, including 61 physicians, nurses, pharmacists and physical therapists, have been charged with approximately $900 million in false billings.

The number of arrests and total amount of alleged fraudulent activity tops last year’s record sweep, which charged 243 people with $712 million in false billings.

About half of the cases involve home health services, with 100 people charged with $220 million in alleged fraud in the Southern District Florida alone. In one case, nine people are being accused of running six home health companies in the Miami area for the sole purpose of submitting $24 million in phony Medicare claims for unnecessary services based on bribes and kickbacks.

“As this takedown should make clear, health care fraud is not an abstract violation or benign offense--it is a serious crime,” U.S. Attorney General Loretta Lynch said in a statement. “The wrongdoers that we pursue in these operations seek to use public funds for private enrichment. They target real people – many of them in need of significant medical care. They promise effective cures and therapies, but they provide none. Above all, they abuse basic bonds of trust--between doctor and patient; between pharmacist and doctor; between taxpayer and government--and pervert them to their own ends.”

The specific charges in the cases range from conspiracy to commit health care fraud to money laundering to identity theft. More than 60 percent of the defendants submitted their allegedly false claims to Medicare Part D, which the DOJ said is Medicare’s fastest-growing component.