On Wednesday, the Justice Department announced that it had brought criminal and civil charges against 301 healthcare professionals as part of the largest national healthcare fraud “takedown” in history. A nationwide investigation spearheaded by the Medicare Fraud Strike Force revealed claims amounting to $900 million in the form of alleged kickbacks, money laundering, and other false billings.
According to the DOJ’s allegations, the defendants participated in schemes to submit claims to Medicare and Medicaid for treatments that were medically unnecessary and, in many cases, never provided. Specifically, some of the cases involved Medicare beneficiaries and co-conspirators receiving kickbacks in return for supplying beneficiary information to providers. These providers then allegedly submitted fraudulent bills to Medicare for unnecessary services.
Based on the charging documents, it’s clear that federal prosecutors have been building these cases over the course of several months. The defendants in these cases were allegedly involved in a series of independent, unrelated schemes in different districts around the country. The reasoning behind bringing these unrelated charges all at once may simply be to send a powerful message of deterrence and to illustrate the government’s increased focus on targeting health care fraud.
The alleged schemes involved a variety of services, including physical and occupational therapy, home health care, prescription drugs, and durable medical equipment. Most of the cases involve physicians and/or clinics. One charge alleges that a physician allowed unlicensed individuals to perform physician services and then billed Medicare as if he performed those services. Another case involved defendants allegedly using bribes to fill a network of clinics with patients. Once at the clinics, these patients underwent medically unnecessary treatments.
The Medicare Fraud Strike Force is part of a joint initiative between the DOJ and the Department of Health and Human Services to concentrate their efforts on prevention of fraud and enforcement of anti-fraud laws.
The takedown sheds light on the DOJ’s increasing focus on detecting health care fraud and holding individuals responsible for fraudulent schemes criminally and civilly accountable. These enforcement actions also track the initiatives of the Yates Memorandum, the government’s recent policy for prosecuting individuals. Because the U.S. government continues to invest a tremendous amount of resources in identifying and prosecuting healthcare fraud, with a focus on individuals, it is crucial that healthcare entities implement robust compliance programs to detect and correct potential misconduct.