The U.S. Department of Justice (DOJ) has indicted 243 people on Thursday for fraud after submitting falsified Medicare billings amounting to $712 million.
The DOJ, along with the Federal Bureau of Investigation (FBI), Department of Health and Human Services (HHS) and local agencies, brought cases in 17 districts, including well-known areas for fraud in New York and Miami.
Those arrested included 46 medical professionals such as doctors, nurses, occupational and physical therapists.
According to the Justice Department, the cases are based on several alleged fraud schemes that involved submission of claims to Medicaid and Medicare for treatments that were deemed unnecessary and often were not provided.
The nationwide crackdown on fraudulent groups was led by the U.S. Centers for Medicare and Medicaid Service, the Medicare Fraud Strike Force and around 900 local law enforcement agents. It is considered to be the largest such sweep in terms of the amount of money lost and the number of people arrested and charged.
U.S. Attorney General Loretta Lynch pointed out that one of those charged with fraud was a Miami-based medical health facility that had billed the Medicare for intensive psychotherapy procedures that amounted to tens of millions of dollars despite only transferring patients from one location to another.
Many of the patients in the facility suffered from Alzheimer's disease and dementia, and they did not have the ability to communicate with alleged caregivers and therapists.
In California and Louisiana, four alleged companies received $22 million-worth of funds from Medicare for sending talking glucose monitors to patients regardless of whether they needed it or not.
The DOJ indicted one pain management physician in Tampa, Florida who was paid over $1 million for studies on nerve conduction and other services that never occurred.
A home care company in Miami was given payments worth $2.5 million for services the facility never performed. The company sent the claim to Medicare even though six of the physicians listed almost never billed the healthcare program for seeing the same patients. One of the doctors disputed that he only saw four of the 188 patients the company claimed he did.
Nine people in Brooklyn, New York were charged by the Justice Department for two separate counts of fraud regarding occupational and physical therapy schemes.
Sylvia Burwell, secretary of the HHS, said that they are now more proactive in eliminating fraudulent claims to Medicare. She said that they have shifted from a "pay and chase" method when it comes to recognizing claims to more of a "prevention model."
Burwell said that the enforcement abilities of federal agencies have been bolstered courtesy of the Affordable Care Act, or more popularly known as Obamacare.
The health care law has provided the federal government an additional $350 million-worth of funds for efforts concerning prevention and law enforcement. It has allowed the DOJ to hire additional prosecutors and expand the agencies handling crackdowns to nine cities from the initial two.
Photo: National Museum of the U.S. Navy | Flickr
