More than 300 people, including 61 doctors, nurses, pharmacists, and physical therapists, have been charged with trying to steal nearly $900 million, in what the Department of Justice proclaims to be the “largest Medicare fraud takedown in history”. Attorney General Loretta E. Lynch and Department of Health and Human Services (HHS) Secretary Sylvia Mathews Burwell announced the development in a press conference yesterday.
The nationwide sweep was led by the Medicare Fraud Strike Force in 36 federal districts, and resulted in both civil and criminal charges to be filed against the accused. 23 state Medicaid Fraud Control Units also participated in the arrests. According to the Justice Department, nearly 50% of the cases involved some kind of home health fraud whereas nearly 25% involved pharmacy fraud.
The defendants were charged with various health care-related crimes such as conspiracy to commit health care fraud, money laundering, aggravated identity theft and violations of anti-kickback laws.
In a press release by the Department of Justice, Attorney General Lynch said, “As this takedown should make clear, health care fraud is not an abstract violation or benign offense – it is a serious crime.”
She explained that many of the defendants arrested have misused public funds for private enrichment, their target being the people of the United States, of which many were in dire need of medical care at the time. She added that they violated the bond between doctors and patients, pharmacists and doctors and taxpayers and the government to fulfill their own needs.
The Attorney General promised a renewed sense of determination at the Department of Justice to ensure that the citizens of America knew that their ‘health care systems works for them — and them alone’.
HHS Secretary Sylvia Burwell assured the public that they are not winding down but are in fact, committing more resources to the cause. “We are continuing to put new tools and additional resources to work, including $350 million from the Affordable Care Act, for health care fraud prevention and enforcement efforts”, said Burwell.
The task force responsible for the biggest Medicare takedown was first started as a joint initiative by the HHS and the Department of Justice in 2009 and now operates as a part the Health Care Fraud Prevention & Enforcement Action Team (HEAT). The Medicare Fraud Task Force involves local, state and federal investigators who use data analysis and increased policing to find cases of fraud. As of yet 2900 individuals involved with $8.9 billion fraud billings to Medicare have been taken down with the help of the task force.
This also marks the second time in which districts outside the Medicare Strike Force jurisdiction participated in the bust. Their actions accounted for 82 of the culprits which were apprehended yesterday.
Attorney General Lynch explained that the new cases showed a troublesome scenario which includes instances of identity theft where people impersonated healthcare personnel to prepare fake prescriptions and a growing trend of compounding or mixing of medications, especially for patients.
According to a report released by the Office of Inspector General, compounded medications are very expensive and Medicare Part D spending for such drugs has continued to rise exponentially.
In 2015, the rate of rise was more than $10 billion a year and spending on commonly abused opioids was more than $4 billion. According to the report, every third beneficiary received a commonly abused opioid which raises concerns about fraud, abuse, and patient safety.
The Justice Department also filed charges against 100 individuals from the Southern District of Florida on related offences such as charging $220 million in false billings for home health care, mental care, and pharmaceutical fraud.
In one of these cases, six different home-based health companies from Miami, under the supervision of nine defendants, have been charged with purposefully submitting fraudulent and false claims to Medicare, which resulted in a payment of $24 million by the Medicare program. The services provided by these health companies, according to the Department of Justice, were medically unnecessary and based on bribes and kickbacks.
Another major sweep was made in the Southern District of Texas where 24 people were charged with fraud involving $146 million.
One of these individuals was John Ramirez, MD, who allegedly billed Medicare with fraudulent fees of $18 million in home healthcare visits which were often medically unnecessary or were not even provided in some cases. Dr Ramirez, aged 62, was charged with four counts of conspiracy to commit health care fraud.
Individuals were charged and arrested from all over the country including Florida, Texas, California, Michigan, Illinois, New York, and Louisiana. The nationwide sweep also included operations in US territories such as the District of Puerto Rico, where six civil demand letters were issued to individuals for their role in a scheme to allegedly defraud the Medicaid Program.