Medicare Fraud Strike Force Charges 91 Defendants with $295 Million False Billing
Largest Single Strike Force Takedown
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Barbara D. Woolley
WASHINGTON D.C. (September 12, 2011) In a coordinated action in eight cities, the Medicare Fraud Strike Force charged 91 defendants with various Medicare fraud schemes totaling approximately $295 million in alleged false billing. The Department of Justice described this as the highest amount of false Medicare billings in a single takedown in Strike Force history. The services involved durable medical equipment (DME), physical and occupational therapy, mental health services, psychotherapy, HIV infusion, and home health care.
We commend the Medicare Fraud Strike Force, a joint Department of Justice-Department of Health & Human Services operation in conjunction with state and local law enforcement, for their efforts to take action against those who commit Medicare fraud, said Val J. Halamandaris, President of the National Association for Home Care & Hospice (NAHC). We agree that our policy must be zero tolerance for those who would steal from the public purse and thus undermine the care being provided to aged and infirm, disabled and dying Americans.
Indictments were issued in Miami, Houston, Baton Rouge, Los Angeles, Detroit, Chicago, Dallas and Brooklyn against an array of professionals, including physicians, nurses, and other medical professionals, as well as against various providers. The defendants were charged with conspiracy to defraud Medicare, health care fraud, violations of the anti-kickback law, and money laundering. Kickback allegations included payments to patient recruiters, Medicare beneficiaries, and others for beneficiary information so that the providers could bill Medicare for services that were medically unnecessary or not furnished. For more information about the indictments, see the Department of Justice press release: www.hhs.gov/news/press/2011pres/09/20110907c.html.
Halamandaris served in both the House of Representatives and Senate where he authored anti-fraud legislation that created the Office of Inspector General in the Department of Health & Human Services as well as state Medicaid fraud units. He also led investigations on health care fraud against the elderly. These abuses still go on today. Halamandaris observes: If the allegations are true, these charges reflect totally inappropriate behavior that impugns the reputation of the vast majority of caring and law-abiding Medicare providers, makes it harder for such honest providers to compete, and steals funds that are otherwise available to Medicare beneficiaries in need of services. NAHC supports the efforts of law enforcement to rid the Medicare program of providers who engage in such illegal conduct.
Several state home care associations, spearheaded by the Michigan Home Health Association, have taken an active role with the HEAT task forces, providing information and insight to law enforcement agencies in their efforts to quickly target fraud, waste, and abuse. This partnering is just one strong indication as to how the home care community leads in improving Medicare and Medicaid program integrity. In the recent reforms to health care fraud laws, NAHC succeeded in getting enacted numerous provisions that help guard and preserve Medicare and Medicaid, such as stricter provider participation standards. “We have helped bring in many improvements to program integrity so far. Continuing our close working relationship with the enforcement agencies will go a long way to further eliminating those bad providers who harm us all,” stated Halamandaris.
The Medicare Fraud Strike Force is a joint Department of Justice-Department of Health & Human Services operation in conjunction with state and local law enforcement. It is part of the Health Care Fraud Prevention and Enforcement Action Team (HEAT) Initiative. You can see the enforcement activity in your state by checking www.stopmedicarefraud.gov, and click on HEAT Task Force in Your Area.
The National Association for Home Care & Hospice (NAHC) is a nonprofit organization that represents the nations 33,000 home care and hospice organizations. NAHC also advocates for the more than two million nurses, therapists, aides and other caregivers employed by such organizations to provide in-home services each year to some 10 million Americans who are infirm, chronically ill, disabled and dying. Along with its advocacy, NAHC is committed to excellence in every respect and provides information to help its members maintain the highest quality of care. To learn more about NAHC, visit www.nahc.org.