Department of Justice

Office of Public Affairs
FOR IMMEDIATE RELEASEThursday, October 4, 2012




Medicare Fraud Strike Force Charges 91 Individuals for Approximately $430 Million in False Billing


Medicare Fraud Strike Force operations in seven cities have led to
charges against 91 individuals – including doctors, nurses and other
licensed medical professionals – for their alleged participation in
Medicare fraud schemes involving approximately $429.2 million in false
billing, Attorney General Eric Holder and Health and Human Services
(HHS) Secretary Kathleen Sebelius announced today.





Attorney General Holder and Secretary Sebelius were joined in the
announcement of the nationwide takedown by Assistant Attorney General
Lanny A. Breuer of the Justice Department’s Criminal Division, FBI
Associate Deputy Director Kevin Perkins, Inspector General Daniel R.
Levinson of the HHS Office of Inspector General (HHS-OIG) and Dr. Peter
Budetti, Deputy Administrator for Program Integrity of the Centers for
Medicare and Medicaid Services (CMS).





“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 Holder. “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.”





“Today’s arrests put criminals on notice that we are cracking down hard
on people who want to steal from Medicare,” said HHS Secretary
Sebelius. “The health care law gives us new tools to better fight
fraud and make Medicare stronger. In addition to the arrests made
today, HHS used new authority from the health care law to stop future
payments to many of the health care providers suspected of fraud, saving
Medicare resources and taxpayer dollars from being lost to fraud in the
first place.”





Dozens of charged individuals were arrested or surrendered in the last
24 hours as indictments were unsealed across the country. Together,
those indictments charge more than $230 million in home health care
fraud; more than $100 million in mental health care fraud and more than
$49 million in ambulance transportation fraud; and millions more in
other frauds.





HHS also suspended or took other administrative action against 30 health
care providers following a data-driven analysis and based upon credible
allegations of fraud. Under the Affordable Care Act, HHS is able to
suspend payments until the resolution of an investigation.





The joint Department of Justice and HHS Medicare Fraud Strike Force is a
multi-agency team of federal, state and local investigators and
prosecutors designed to combat Medicare fraud through the use of
Medicare data analysis techniques. More than 500 law enforcement
agents from the FBI, HHS-OIG, multiple Medicaid Fraud Control Units, and
other state and local law enforcement agencies participated in the
takedown.





The defendants charged are accused of various health care fraud-related
crimes, including conspiracy to commit health care fraud, health care
fraud, violations of the anti-kickback statutes and money laundering.
The charges are based on a variety of alleged fraud schemes involving
various medical treatments and services such as home health care, mental
health services, psychotherapy, physical and occupational therapy,
durable medical equipment (DME) and ambulance services.





According to court documents, the defendants allegedly participated in
schemes to submit claims to Medicare for treatments that were medically
unnecessary and oftentimes never provided. In many cases, court
documents allege that patient recruiters, Medicare beneficiaries and
other co-conspirators were paid cash kickbacks in return for supplying
beneficiary information to providers, so that the providers could submit
fraudulent billing to Medicare for services that were medically
unnecessary or never provided. Collectively, the doctors, nurses,
licensed medical professionals, health care company owners and others
charged are accused of conspiring to submit a total of approximately
$429.2 million in fraudulent billing.





“Today’s coordinated actions represent one of the largest Medicare fraud
takedowns in Department of Justice history, as measured by the amount
of alleged fraudulent billings,” said Assistant Attorney General
Breuer. “We have made it one of the Department’s missions to hold
accountable those who abuse the Medicare program for personal profit.
And there are Medicare fraudsters in prisons across the country – some
who will be there for decades – who can attest to our determination, and
our effectiveness.”





“Health care fraud leads to higher health care costs and makes quality
care more difficult to obtain,” said FBI Associate Deputy Director
Perkins. “Working together to stop fraud, as we did today, will ensure
that Americans’ hard-earned dollars are used to care for the sick – not
to line the pockets of criminals.”





“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.”





“This is the result of coordinated anti-fraud efforts – including
Medicare flagging suspicious activity, efforts between agencies to
investigate this criminal activity, and today’s actions by law
enforcement and HHS,” said CMS Deputy Administrator for Program
Integrity Budetti. “As we stop payments to these providers suspected
of fraud, we continue our efforts to move from a pay-and-chase model to
one where we stop fraudsters before they can successfully bill Medicare
and Medicaid.”





In Miami, a total of 33 defendants are charged for their alleged
participation in various fraud schemes involving a total of $204.5
million in false billings for home health care, mental health services,
occupational and physical therapy, and DME. In one case, three
defendants are charged for participating in a fraud scheme at LTC
Professional Consultants and Professional Home Care Solutions Inc. which
led to approximately $74 million in fraudulent billing for home health
care. In another case, five defendants are charged for participating
in a fraud scheme at Hollywood Pavilion which led to $67 million in
fraudulent billing for mental health services.





Sixteen individuals, including three doctors and one licensed physical
therapist, are charged in Los Angeles with participating in various
fraud schemes involving a total of $53.8 million in false billings. In
one case, four defendants are charged for allegedly participating in a
fraud scheme at Alpha Ambulance Inc., which led to approximately $49.2
million in fraudulent billing for ambulance transportation. The case
represents the largest ambulance fraud scheme ever prosecuted by the
Medicare Fraud Strike Force. According to court documents, the
defendants provided beneficiaries ambulance rides that were medically
unnecessary.





In Dallas, 14 individuals – including two doctors and two registered
nurses – are charged for their alleged participation in various fraud
schemes involving a total of $103.3 million in false billings. In one
case, three defendants – a medical doctor and two registered nurses –
are charged with participating in a fraud scheme at Raphem Medical
Practice and PTM Healthcare Services which led to approximately $100
million in fraudulent billing for home health care services. According
to court documents, Dr. Joseph Megwa signed approximately 33,000
prescriptions for more than 2,000 unique Medicare beneficiaries from
2006 to 2011. Many of these Medicare beneficiaries had primary care
physicians who never certified home healthcare services for them. In
order to handle the volume of prescriptions, Megwa allegedly signed
stacks of documents without reviewing them.





Seven individuals are charged in Houston for their participation in a
fraud scheme at a hospital which led to $158 million in fraudulent
billing for community mental health center services. According to
court documents, 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). Allegedly,
beneficiaries watched television, played games and engaged in other
non-PHP activities rather than receiving the services for which the
hospital billed Medicare. Previously, on Feb. 22, 2012, the assistant
administrator of the hospital, Mohammad Kahn, pleaded guilty to
conspiracy to commit health care fraud and paying kickbacks related to
$116 million worth of fraudulent claims submitted to Medicare. After
his guilty plea, an additional $42 million in fraudulent claims were
discovered that are included in today’s totals.





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.





In Chicago, two defendants, including a dermatologist and a
psychologist, are charged for their roles in fraud schemes involving,
according to court documents, millions of dollars in false claims for
medically unnecessary laser treatments and psychotherapy services.





The Medicare Fraud Strike Force operations are part of the Health Care
Fraud Prevention & Enforcement Action Team (HEAT), a joint
initiative announced in May 2009 between the Department of Justice and
HHS to focus their efforts to prevent and deter fraud and enforce
current anti-fraud laws around the country.





Since their inception in March 2007, strike force operations in nine
locations have charged more than 1,480 defendants who collectively have
falsely billed the Medicare program for more than $4.8 billion. In
addition, the HHS Centers for Medicare and Medicaid Services, working in
conjunction with the HHS-OIG, are taking steps to increase
accountability and decrease the presence of fraudulent providers.

The
cases announced today are being prosecuted and investigated by Medicare
Fraud Strike Force teams comprising attorneys from the Fraud Section of
the Justice Department’s Criminal Division and from the U.S. Attorneys’
Offices for the Southern District of Florida, the Southern District of
Texas, the Northern District of Texas, the Central District of
California, the Middle District of Louisiana, the Northern District of
Illinois, and the Eastern District of New York, and agents from the FBI,
HHS-OIG and state Medicaid Fraud Control Units, with assistance from
the Justice Department’s Civil Division and the IRS.


The charges and allegations contained in the indictments are merely
accusations and the defendants are presumed innocent unless and until
proven guilty.


http://www.justice.gov/opa/pr/2012/October/12-ag-1205.html