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11-10-2012 | Article

Medicare charge multiple healthcare professionals for billing fraud


Department of Justice statement

medwireNews: The Medicare Fraud Strike Force has charged 91 individuals in six states with racking up $ 429.2 million in phony claims.

The Strike Force, a joint enforcement arm of the Department of Justice (DOJ) and the Department of Health and Human Services (HHS), arrested doctors, nurses, and other healthcare professionals across the country and charged them with a variety of counts, including home healthcare fraud, mental health services fraud, and bogus ambulance charges.

The enforcement actions "reveal an alarming and unacceptable trend of individuals attempting to exploit federal health care programs to steal billions in taxpayer dollars for personal gain," said US Attorney General Eric Holder at a briefing.

"Such activities not only siphon precious taxpayer resources, drive up healthcare costs, and jeopardize the strength of the Medicare program - they also disproportionately victimize the most vulnerable members of society, including elderly, disabled and impoverished Americans."

HHS Secretary Kathleen Sebelius, noted at the briefing that "in addition to the arrests made today, HHS used new authority from the healthcare law to stop future payments to many of the healthcare providers suspected of fraud, saving Medicare resources and taxpayer dollars from being lost to fraud in the first place."

The arrests included 33 people in Miami, Florida, a city notorious for its profusion of fraudulent Medicare and Medicaid clinics. The defendants are charged with participating in false billing for home healthcare, mental health services, physical and occupational therapy and durable medical equipment (DME) totaling $ 204.5 million.

In Los Angeles, California, 16 people, including three doctors and a licensed physical therapist, have been charged with taking Medicare for a $ 53.8 million dollar ride. A hefty chunk of that total is accounted for by $ 49.2 million in medically unnecessary ambulance trips.

Other indictments were handed down against 14 people in Dallas, Texas, who are charged with $ 103.3 million in phony claims; seven people in Houston, Texas, who are alleged to have taken part in a fraud scheme at a hospital, netting $ 158 million in bogus mental health service charges; 15 people in Brooklyn, New York, including a doctor and four chiropractors, who are under indictment for $ 23.2 million in various fraud schemes; four people in Baton Rouge, Louisiana - including a licensed practical nurse - who are alleged to have run up $ 2.4 million in claims for medically unnecessary DME; and a dermatologist and psychologist in Chicago, Illinois, who are charged with millions of dollars in trumped up claims for unnecessary laser treatments and psychotherapy.

By Neil Osterweil, medwireNews reporter