More than 240 individuals – including doctors, nurses, and other licensed professionals – were arrested this week for their alleged participation in Medicare fraud schemes involving approximately $712 million in false billings. The arrests, which began Tuesday, were part of a coordinated operation in 17 cities by Medicare Fraud Strike Force teams, which include personnel from the FBI, the Department of Health and Human Services (HHS), the Department of Justice (DOJ), and local law enforcement.
At a press conference at DOJ Headquarters in Washington, D.C., officials said the arrests constituted the largest-ever health care fraud takedown in terms of both loss amount and arrests. “These are extraordinary figures,” said Attorney General Loretta Lynch. “They billed for equipment that wasn’t provided, for care that wasn’t needed, and for services that weren’t rendered.”
The charges are based on a variety of alleged fraud schemes involving medical treatments and services. According to court documents, the schemes included submitting claims to Medicare for treatments that were medically unnecessary and often not provided. In many of the cases, Medicare beneficiaries and other co-conspirators were allegedly paid cash kickbacks for supplying beneficiary information so providers could submit fraudulent bills to Medicare. Forty-four of the defendants were charged in schemes related to Medicare Part D, the prescription drug benefit program, which is the fastest growing component of Medicare and a growing target for criminals.
“There is a lot of money there, so there are a lot of criminals,” said FBI Director James B. Comey. He described how investigations leveraged technology to collect and analyze data, and rapid response teams to surge where the data showed the schemes were operating. “In these cases, we followed the money and found criminals who were attracted to doctors offices, clinics, hospitals, and nursing homes in search of what they viewed as an ATM.”
Two Los Angeles doctors are among nine Californians charged with defrauding Medicare out of $66 million by submitting bills for unnecessary services and equipment. Federal prosecutors contend that Dr. Joseph Altamirano bilked Medicare out of nearly $23 million through phony billing and referrals for medical equipment that wasn’t needed, including 1,000 power wheelchairs. Dr. Robert A. Glazer allegedly signed prescriptions for unnecessary services and medical equipment. Prosecutors say the prescriptions were sold to medical providers who used them to collect $22 million from Medicare.
In Miami, 73 were charged in schemes involving about $263 million in false billings for pharmacy, home health care, and mental health services.
More than 900 law enforcement officials participated in the three-day sweep. Those arrested include 46 licensed medical professionals, including 19 doctors. Since 2007, the Medicare Fraud Strike Force has prosecuted more than 200 doctors and more than 400 medical professionals.