National Medicare Fraud Takedown Results in Charges Against 243 Individuals for Approximately $712 Million in False Billing
“This action represents the largest criminal health care fraud takedown in the history of the Department of Justice, and it adds to an already remarkable record of enforcement,” said Attorney General Lynch. “The defendants charged include doctors, patient recruiters, home health care providers, pharmacy owners, and others. They billed for equipment that wasn’t provided, for care that wasn’t needed, and for services that weren’t rendered. In the days ahead, the Department of Justice will continue our focus on preventing wrongdoing and prosecuting those whose criminal activity drives up medical costs and jeopardizes a system that our citizens trust with their lives. We are prepared – and I am personally determined – to continue working with our federal, state, and local partners to bring about the vital progress that all Americans deserve.”
Medicare Fraud Reporting Center
Medicare Whistleblowers are typically healthcare professionals who are aware of hospitals, clinics, pharmacies, Nursing Homes, Hospices, long term care and other health care facilities that routinely overcharge or seek reimbursement from government programs for medical services not rendered, drugs not used, beds not slept in and ambulance rides not taken. If you have information about a person or a company that is cheating the Medicare program (or any other government run healthcare program), you may be able to collect a large financial reward for reporting it here.
Biggest healthcare frauds in 2015: Running list
Two Southern California residents, Theresa Fisher, 45, and Lindsay Hardgraves, 30, were both found guilty of mail fraud for submitting bills for more than $71 million for medically unnecessary procedures performed on insurance beneficiaries who received free or discounted cosmetic surgeries. Members of the scheme lured insured patients to a surgery center in Orange with promises that they could use their union or PPO health insurance plans to pay for cosmetic surgeries, which are generally not covered by insurance. The surgery center was known at various times as Princess Cosmetic Surgery, Vista Surgical Center, and Empire Surgical Center. The women told patients they could receive free or discounted cosmetic surgeries if they underwent medical procedures covered by their insurance such as endoscopies, colonoscopies and cystoscopies. Once the health care benefit program paid the claims, the patients were given free or discounted cosmetic surgeries, including “tummy tucks,” breast augmentations and liposuction. In some cases, the surgery center simply billed cosmetic procedures as if they were medically necessary procedures such as hernia surgeries.
Criminal and Civil Enforcement
New York City Pharmacy Owner Arrested For $8.5 Million Fraud As Part Of Largest National Medicare Fraud Takedown In History Preet Bharara, the United States Attorney for the Southern District of New York, Diego Rodriguez, the Assistant Director-in-Charge of the New York Office of the Federal Bureau of Investigation (“FBI”), and Scott J. Lampert, the Special Agent-in-Charge of the New York Office of the Department of Health and Human Services, announced today that SAJID JAVED was charged with participating in a health care fraud scheme that used nine pharmacies in Brooklyn and Queens, New York, through which JAVED submitted more than $8.5 million in fraudulent claims to Medicaid and Medicare. JAVED’s arrest is part of an unprecedented nationwide sweep led by the Medicare Fraud Strike Force, resulting in criminal and civil charges against 301 individuals, including 61 doctors, nurses, or other licensed medical professionals, for their alleged participation in health care fraud schemes involving approximately $900 million in false billings. Twenty-three state Medicaid Fraud Control Units also participated in today’s arrests. In addition, the HHS Centers for Medicare & Medicaid Services (“CMS”) also suspended a number of providers using its suspension authority provided in the Affordable Care Act. This coordinated takedown is the largest in the history of the Medicare Fraud Strike Force, both in terms of the number of defendants charged and loss amount.
Doctors and nurses busted for $712 million Medicare fraud
A Los Angeles doctor is charged for allegedly billing $23 million for 1,000 power wheelchairs and home health services that were not medically necessary and often not provided. And in a Florida case, a health care provider received $1.6 million from Medicare for prescription drugs that were never purchased and never dispensed, said Lynch.