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.
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.”
Criminal and Civil Enforcement
Cardiologist, Neurologist, And Others Charged In $50 Million Health Care Fraud Scheme, And Civil Suit Filed Against Clinic And Participants In The Fraud Preet Bharara, the United States Attorney for the Southern District of New York, William F. Sweeney Jr., the Assistant Director-in-Charge of the New York Field Office of the Federal Bureau of Investigation (“FBI”), Scott J. Lampert, Special Agent-in-Charge of the New York Regional Office of the United States Department of Health and Human Services Office of the Inspector General (“HHS-OIG”), and James P. O’Neill, the Commissioner of the New York City Police Department (“NYPD”), announced today criminal and civil actions relating to a 12-year scheme to defraud Medicaid, Medicare, and other private health insurance companies out of more than $50 million. Today’s actions include the unsealing of an Indictment charging ASIM HAMEEDI, FAWAD HAMEEDI, MICHELLE LANDOY, DESIREE SCOTT, EMAD SOLIMAN, and ARIF HAMEEDI with, among other things, health care fraud, identity theft, and making false statements, and the filing of a civil fraud lawsuit against CITY MEDICAL ASSOCIATES, P.C., and ASIM HAMEEDI, among others, seeking treble damages and civil penalties under the False Claims Act for the fraudulent claims for reimbursement submitted by CITY MEDICAL ASSOCIATES to Medicare and Medicaid between 2003 and November 2015.
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.
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.
Health Care Fraud — FBI
The Bureau seeks to identify and pursue investigations against the most egregious offenders involved in health care fraud through investigative partnerships with other federal agencies, such as Health and Human Services-Office of Inspector General (HHS-OIG), Food and Drug Administration (FDA), Drug Enforcement Administration (DEA), Defense Criminal Investigative Service (DCIS), Office of Personnel Management-Office of Inspector General (OPM-OIG), and Internal Revenue Service-Criminal Investigation (IRS-CI), along with various state Medicaid Fraud Control Units and other state and local agencies. On the private side, the FBI is actively involved in the Healthcare Fraud Prevention Partnership, an effort to exchange facts and information between the public and private sectors in order to reduce the prevalence of health care fraud. The Bureau also maintains significant liaison with private insurance national groups, such as the National Health Care Anti-Fraud Association, the National Insurance Crime Bureau, and private insurance investigative units.