Government Makes Arrests for $430 Million in Health Care Fraud

Oct. 4, 2012 -- Nearly 100 people have been arrested in a series of raids targeting health care fraud on a massive scale. Doctors, nurses, even top hospital administrators in eight cities in seven states were arrested in connection with separate scams totaling $430 million -- nearly a half billion dollars in pilfering. All kinds of fraud are alleged, much of it involving false billing for services that were unnecessary, or never even rendered.

"Today's enforcement actions reveal an alarming and unacceptable trend of individuals attempting to exploit federal health care programs to steal billions in taxpayer dollars for personal gain," said Attorney General Eric Holder during a press conference in Washington, D.C. "Such activities not only siphon precious taxpayer resources, drive up health care costs, and jeopardize the strength of the Medicare program -- they also disproportionately victimize the most vulnerable members of society, including elderly, disabled and impoverished Americans."

Ninety-one alleged fraudsters were targeted in cities that include Los Angeles; Miami; Dallas; Houston; Tampa; Baton Rouge; Chicago; and Brooklyn, N.Y. Together, those indictments charge more than $230 million in home health care fraud, more than $100 million in mental health care fraud, more than $49 million in ambulance transportation fraud, and millions more in other frauds. The defendants charged are accused of various crimes, including conspiracy to commit health care fraud, health care fraud, violations of the anti-kickback statutes, and money laundering.

"Today's coordinated operation demonstrates that law enforcement is flexible enough to address health care fraud in its many evolving forms," said HHS Inspector General Levinson. "When home health agencies, durable medical equipment companies, pharmacies or other health care providers are suspected of breaking the law, they can expect to be caught and held accountable."

Some of the government accusations involve allegations of stunning audacity.

According to the Justice Department, seven individuals are charged in Houston for their participation in a fraud scheme at a hospital that led to $158 million in fraudulent billing for community mental health center services. "The defendants who served as administrators at the hospital paid kickbacks – in the form of cigarettes, food and coupons redeemable for items available at the hospital's 'country stores' -- to Medicare beneficiaries in exchange for those beneficiaries' attendance at the hospital's partial hospitalization programs (PHP)," Justice Department officials said. "Allegedly, beneficiaries watched television, played games and engaged in other non-PHP activities rather than receiving the services for which the hospital billed Medicare."

"In Brooklyn, 15 individuals, including one doctor and four chiropractors, are charged for their alleged participation in various fraud schemes involving a total of $23.2 million in false billings. In one case, nine defendants, including a medical doctor, are charged with participating in a fraud scheme at Cropsey Medical Care PLLC which led to approximately $13.8 million in fraudulent billing for physical therapy and related services. According to court documents, the defendants paid cash kickbacks to Medicare beneficiaries in exchange for physical therapy that was not medically necessary and on some occasions never provided to beneficiaries."

"In Baton Rouge, four defendants, including a licensed practical nurse, are charged for their roles in fraud schemes involving approximately $2.4 million in false claims for medically unnecessary durable medical equipment."

Since its inception in March 2007, the federal strike force has charged more than 1,480 defendants who collectively have falsely billed the Medicare program for more than $4.8 billion.