Doctors and Nurses Charged in Massive $900 Million Medicare Fraud
Policy + Politics

Doctors and Nurses Charged in Massive $900 Million Medicare Fraud


In some cases, doctors took part in schemes to submit claims to Medicare and Medicaid for treatments that were not necessary and were never provided. In others, health care providers offered kickbacks to “patient recruiters” to help assemble beneficiary information that could be used in phony filings. 

One of the biggest scams involved phony billings for costly prescription drugs at a time when Medicare’s drug costs are spiking.

Related: Billions in Medicare Fraud Still Rampant Despite Federal Crackdown

Taken together, doctors, nurses, licensed medical professionals and health care companies conspired to submit a total of $900 million in fraudulent billing in the past year to the premier federal programs providing health care to the elderly and poor, according to joint announcements on Wednesday by the Justice Department, the Department of Health and Human Services and the FBI.

The latest chapter in the federal government’s highly touted “National Health Care Fraud Takedown” netted 301 defendants in all, including 61 doctors, nurses and other licensed medical professionals, for their involvement in conspiracies to rip off the government. President Obama made the crackdown on Medicare and Medicaid fraud a high priority in his second term.

Since 2010, federal authorities operating as part of the “Fraud Takedown” initiative have arrested and charged roughly 1,200 people allegedly complicit in defrauding the Medicare and Medicaid programs of more than $3.5 billion.

The most recent charges came after investigators uncovered a wide array of alleged fraud schemes involving a host of medical treatments and services, such as home health care, physical and occupational therapy, durable medical equipment sales and prescription drugs, according to authorities. More than 60 of those arrested were charged with fraudulent claims for Medicare Part D prescription drug benefits, which were deemed the “fastest-growing component” of the Medicare program overall.

Related: Audit Uncovers $124.7 B of Overpayments and Fraud in Medicare and Medicaid

“As this takedown should make clear, health care fraud is not an abstract violation or benign offense – It is a serious crime,” Attorney General Loretta E. Lynch said in a statement. “The wrongdoers that we pursue in these operations seek to use public funds for private enrichment.  They target real people – many of them in need of significant medical care.  They promise effective cures and therapies, but they provide none.”

Lynch and other officials described the fraudulent activities by medical professionals as a gross betrayal of the public trust that targets the most vulnerable in society by taking taxpayer money away from the care of the elderly, children and the disabled. Assistant Attorney General Leslie R. Caldwell said the government has perfected techniques for ferreting out Medicare and Medicaid fraud and described the strike force as a “model of 21st Century data-driven enforcement.”

“As the cases announced today demonstrate, the Strike Force’s strategic approach keeps us a step ahead of emerging fraud trends, including drug diversion, and fraud involving compounded medications and hospice care,” Caldwell said.

Related: Medicare Drug Program Still Plagued by Fraud 

HHS Secretary Sylvia Mathews Burwell noted that $350 million was earmarked as part of the Affordable Care Act for health care fraud prevention and enforcement efforts. “Millions of seniors depend on Medicare for essential health coverage, and our action shows that this administration remains committed to cracking down on individuals who try to defraud the program,” she said.

From a regional perspective, the Southern District of Florida was a beehive of illegal activity. One hundred people were charged with offenses involving fraudulent schemes totaling $200 million in false billings for home health care, mental health services and pharmacy fraud.

In the Southern District of Texas, 24 people were charged in cases involving over $146 million of alleged fraud. One of the defendants was described as a doctor with the highest number of referrals for home health services in the region. In central California, meanwhile, 22 people were rounded up and charged with conspiracies to defraud the Medicare program of roughly $162 million.

In one case, a physician cheated Medicare out of $12 million through a series of phony billings and by performing medically unnecessary vein ablation procedures on Medicare beneficiaries.