BUSTED: Federal Agents Crack Medicare Fraud Operations in 5 Cities

Nearly 100 people charged with making more than $251 million in false claims.

July 16, 2010, 12:16 PM

July 16, 2010— -- Federal agents swept down on alleged Medicare fraud operations in five cities this morning, charging 94 people with submitting more than $251 million in false claims to the government. Agents executed search warrants and made arrests in Miami; Baton Rouge, La.; Brooklyn, N.Y.; Detroit and Houston.

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The defendants arrested today include doctors, nurses, health care company owners and a medical biller who alone was charged with submitting more than $49 million in fraudulent services.

The schemes worked this way: The government said doctors, nurses and health care professionals accepted cash kickbacks from medical service providers to approve services that were unnecessary or never delivered. Then the service provider would bill Medicare for the bogus services, including HIV infusions, home health care and physical and occupational therapy.

Medicare fraud results in an estimated $60 billion in annual losses for the government.

In an ABC News investigation last year, correspondent Pierre Thomas found some supposed Medicare medical providers had business locations that were in reality empty offices or warehouses, with no inventory and no services offered. Earlier this year, ABC uncovered a Medicare fraudster who was helping a drug cartel smuggle guns to Mexico, and an ethnic gang that was using violence and intimidation to get Medicare money.

Attorney General Eric Holder said today's arrests were the largest health care fraud takedown since a special Medicare fraud strike force unit was established in 2007. The task force pulls investigators from a number of law enforcement agencies, including the FBI.

$251 Million in Medicare Fraud

"Today's charges allege attempts by individuals to defraud the Medicare program of $251 million," said FBI Director Robert S. Mueller III. "Countless Americans rely on Medicare for their well-being, and the FBI, working in conjunction with our federal agency partners, is resolute in its commitment to stop those who would illegally manipulate the system."

Today's arrests occurred in five cities:

In Miami, 24 defendants were charged with allegedly participating in various fraud schemes that led to approximately $103 million in false billings. The defendants included owners and operators of companies, doctors, nurses and patient recruiters, as well as a medical biller who is alleged to have billed approximately $49 million in fraudulent services.

In Baton Rouge, 31 defendants were charged for various schemes allegedly involving fraudulent claims for durable medical goods (such as wheelchairs) totaling approximately $32 million. The defendants include the owners and operators of nine different purported medical service companies and four doctors, 14 patient recruiters and other individuals who allegedly worked at the medical services companies.

In Brooklyn, 22 defendants were charged for their alleged participation in schemes to submit fraudulent claims totaling approximately $78 million. The defendants included the owners and operators, patient recruiters and employees at three different purported medical clinics and a medical equipment company, as well as three doctors.

In Detroit, 11 defendants were charged for their alleged roles in schemes to submit $35 million in fraudulent claims to Medicare for home health services, nerve conduction tests and injection and infusion therapy sessions.

In Houston, four defendants were also charged for their alleged roles in a $3 million scheme to submit fraudulent claims for durable medical equipment.

In addition to making arrests today, law enforcement agents are executing search warrants in connection with ongoing health care fraud investigations in all five cities.

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