Health Care

Medicare Fraud Sting Nets $50 Million, Indicts 53 Doctors

| by DOJ

WASHINGTON – Fifty-three people have been indicted for schemes to
submit more than $50 million in false Medicare claims in the continuing
operation of the Medicare Fraud Strike Force in Detroit, Attorney
General Eric Holder, Department of Health and Human Services (HHS)
Secretary Kathleen Sebelius and FBI Director Robert Mueller announced
today. The Strike Force in Detroit is the third phase of a targeted
criminal, civil and administrative effort against individuals and
health care companies that fraudulently bill the Medicare program.

While the indictments were returned by a grand jury in Detroit,
individuals were arrested today in Detroit, Miami and Denver as a
result of phase three operations of the Strike Force. The joint DOJ-HHS
Medicare Fraud Strike Force is a multi-agency team of federal, state
and local investigators designed to combat Medicare fraud through the
use of Medicare data analysis techniques and an increased focus on
community policing.

"As demonstrated by today’s charges and arrests, we will strike back
against those whose fraudulent schemes not only undermine a program
upon which 45 million aged and disabled Americans depend, but which
also contribute directly to rising health care costs that all Americans
must bear," said Attorney General Holder. "The vast majority of
doctors, patients, and medical companies do the right thing and work
with the Medicare program to provide access to medical services. To
those who work diligently and ethically to provide medical care through
the Medicare program, we will work with you to root out the few who
corrupt the system and taint the good reputations of health
professionals everywhere."

"The Obama Administration is committed to turning up the heat on
Medicare fraud and employing all the weapons in the federal
government’s arsenal to target those who are defrauding the American
taxpayer," said HHS Secretary Kathleen Sebelius. "Thanks to cooperation
from across the government and some of the best law enforcement
professionals in the country, today we were able to save millions of
dollars from being lost to criminals and send a powerful message to
those who seek to defraud the system, that we are coming after them.
But our joint efforts on HEAT don’t just stop at the jailhouse door.
Our Medicare program is working closely in partnership with our own and
other law enforcement operations to prevent fraud from happening in the
first place. Every dollar we can save by stopping fraud can be used to
strengthen the long-term fiscal health of Medicare, bring down costs
and deliver better service to Medicare beneficiaries."

The Strike Force operations in Detroit are part of the Health Care
Fraud Prevention & Enforcement Action Team (HEAT), a renewed effort
announced in May 2009 between the Department of Justice and HHS to
focus their joint efforts to prevent fraud and enforce current
anti-fraud laws around the country. The HEAT taskforce, co-chaired by
Deputy Attorney General David Ogden and Deputy Secretary Bill Corr, is
made up of top-level law enforcement agents, prosecutors and staff from
both Departments and their operating divisions. In the May 2009
announcement, Attorney General Holder and Secretary Sebelius announced
the expansion of the Strike Force into Detroit and Houston to build
upon existing partnerships between the agencies in a heightened effort
to reduce fraud and recover taxpayer dollars.

Today, federal agents from the FBI and the HHS Office of Inspector
General (HHS-OIG) began executing arrest warrants in Detroit, Miami and
Denver as part of a concentrated effort to address fraud in the
metro-Detroit area. Charges were unsealed today against 53 individuals
who are accused of various Medicare fraud offenses, including
conspiracy to defraud the Medicare program, criminal false claims and
violations of the anti-kickback statutes. The Strike Force operations
in Detroit have identified two primary areas – infusion therapy and
physical/occupational therapy providers – in which schemes were
allegedly orchestrated to defraud the Medicare program.

According to the indictments, the defendants charged today participated
in schemes to submit claims to Medicare for treatments that were in
fact medically unnecessary and oftentimes, never provided. In many
cases, indictments allege that beneficiaries accepted cash kickbacks in
return for allowing providers to submit forms saying they had received
the unnecessary and not provided treatments. Collectively, the
physicians, medical assistants, patients, company owners and executives
charged in the indictments are accused of conspiring to submit more
than $50 million in false claims to the Medicare program.

"We will continue to work together in the months to come to identify
and stop those who would line their own pockets with taxpayer money
those who seek to benefit at the expense of our health care system, our
economy and our collective well-being," said FBI Director Mueller.

"Today’s landmark series of arrests in Detroit and across the country
demonstrates that health care fraud can happen anywhere in America,"
said Daniel R. Levinson, Inspector General of the Department of Health
& Human Services. "We will continue to detect and respond rapidly
to emerging fraud schemes to protect our federal health care programs
and conserve scarce health care dollars so critically needed for the
care of our beneficiaries."

The work of the Detroit Strike Force is another important step in the
multi-phase enforcement and regulatory HEAT initiative designed to
reduce the potential for Medicare and Medicaid fraud. Since its
inception in March 2007 with phase one in South Florida and expansion
to phase two in Los Angeles in May 2008, the Strike Force has obtained
indictments of more than 250 individuals and organizations that
collectively have billed the Medicare program for more than $600
million. In addition, HHS’s Centers for Medicare and Medicaid Services,
working in conjunction with the HHS-OIG, is taking steps to increase
accountability and decrease the presence of fraudulent providers.