In 2014, the federal government recovered nearly $5.7 billion in fraud cases, up $1.9 billion from the prior fiscal year. Of that amount, $2.3 billion was tied to fraud against the federal government. Already, 2015 has seen a host of major fraud news involving dozens of individuals and amounting to millions in abuse, often related to Medicare fraud.
$100 Million: Thirty-seven people, including 24 doctors, pleaded guilty to a massive healthcare bribery scheme resulting in more than $100 million in payments from Medicare and various private insurance companies to Biodiagnostic Laboratory Services in New Jersey. On March 3, Michael J. Zarrelli, 48, of Berkeley Heights, New Jersey pleaded guilty to bribing a doctor in exchange for test referrals.
$75 Million: Community Health Systems and three of its hospitals in New Mexico in February agreed to pay a $75 million settlement to the federal government over a whistleblower suit that claimed it illegally donated money between 2000 and 2011 to New Mexico counties in return for higher Medicaid payments to cover the costs of indigent care. The activity was uncovered by whistleblower Robert Baker, a former revenue manager at Community Health Systems Professional Services Corp.
$30 Million: Operators of a Louisiana home care company, Priority Care at Home, as well as 20 other accomplices were indicted in March for their alleged role in a $30 million Medicare fraud scheme. The defendants allegedly hired “house doctors” to sign orders and plans of care for Medicare beneficiaries who had no legitimate medical necessity for home health services.
$14 Million: Jonathan Wade Dunning, a former CEO of two nonprofit health clinics in Alabama, was arrested in February on 112 counts related to alleged conspiracy, fraud and money-laundering of cash meant for the poor and homeless. The charges allege Dunning, as CEO and in other positions, participated in conspiracy and executed schemes to defraud Birmingham Health Care, Central Alabama Comprehensive Health and others of “substantial resources,” according to the indictment.
$7.9 Million: Pharmaceutical giant AstraZeneca in February agreed to pay the government $7.9 million to settle allegations that it engaged in a kickback scheme regarding its drug Nexium. The complaint said AstraZeneca paid Medco Health Solutions, a pharmacy benefit manager, in exchange for Medco maintaining Nexium’s “sole and exclusive” status on certain Medco formularies and through other marketing activities.
$6.9 Million: Orelvis Olivera, a 45-year-old owner of Acclaim Home Health Care in Miami, in February admitted to running a $6.9 million Medicare fraud in which he and his conspirators billed the government for expensive therapies that patients did not need.
$3.5 Million:The New York-based Catholic Health Care System, an operator of skilled nursing facilities, agreed in March to pay $3.5 million to settle allegations that it inflated Medicare claims for rehabilitation therapy.
$1.6 Million: Vivian Yusuf, 44, the former owner of the Houston-area Ivy Health Care Supply company in February was sentenced to 7 years federal prison and ordered to pay $1.6 million in restitution on a conviction of conspiracy to commit healthcare fraud. From June 2007 to May 2009, Yusuf and co-conspirators improperly acquired Medicare patient information to submit false claims to Medicare totaling more than $3.4 million.
$1.1 Million: A Texas man impersonating an MRI salesman working with Cerner Corp. convinced employees of a Dallas hospital to wire him more than $1 million using an elaborate network of fake correspondence and several co-conspiratorsi. Albert Davis, 54, of Richardson, Texas, was charged with wire fraud after employees of Dallas Medical Center and Prime Health Care — which acquired the hospital during the course of the scheme — transmitted two wire payments totaling $1.1 million to the conspirators’ bank account to purchase the MRI.