Officials said it was the largest takedown in the nine-year history of the Medicare Fraud Strike Force, a joint initiative between federal, state and local law enforcement.
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US law enforcement officials have charged 301 suspects with trying to defraud Medicare and other federal insurance programs in 2016, marking the “largest takedown” involving health care fraud allegations, the Justice Department said on Wednesday. Health care services and providers involved in the various schemes included home health care, psychotherapy, physical and occupational therapy, durable medical equipment (DMA) and prescription drugs.
At least 28 doctors were among those charged with a range of offenses, including conspiracy, bribery, money laundering, kickback violations and identity theft, according to federal documents. A Detroit clinic billed Medicare for more than $36 million, even though Lynch said it was actually a front for a narcotics diversion scheme.
“One of these defendants is a physician with the highest number of referrals for home health services in the Southern District of Texas”, according to the DOJ. In that case, a doctor was indicted for billing $38 million for home health services that were not needed or ever provided. Some of the defendants were paid kickbacks for providing information for fraudulent bills. Patient records were “routinely fabricated and altered” in claims made to Medicare.
“The Department of Justice is determined to continue working to ensure that the American people know that their health care system works for them – and them alone”, Lynch said. “As this takedown should make clear, healthcare fraud is not an abstract violation”.
Those charged “target real people – many of them in need of significant medical care”, Lynch said. They promise effective cures and therapies, but they provide none.
Mitre Corp.is using Neo Technologies’ Neo4j – which gathers data and presents them as a set of related events – to identify patterns in the relationship between doctors and their patients that could point to drug abuse.
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The fraud simply won’t go away because “it’s easy money”, U.S. Attorney Wifredo Ferrer told the Miami Herald, noting the new South Florida cases “show the infiltration of fraud at every level of the healthcare process”.
