Medicare Health Care Fraud

Some Involve Home Health Services.

I feel like I’m having déjà vu. In February I posted the blog Health Care Fraud Scheme.  At the time I thought for sure this would be the largest thing to hit the presses, at least for the year.  A $375M scheme involving fraudulent claims for home health services… This was big news.

Let’s fast forward about 60 days.  We again hear the phrase, “the highest amount of false Medicare billings in a single takedown.”  In the span of less than 3 months we’ve had $827M in health care fraud arrests. I’m dumbfounded and saddened by this.

The latest arrests involve 107 health care providers in seven cities across the country.  Cities involved include Miami, Los Angeles, Houston, Detroit, Chicago, Tampa and Baton Rouge.  The largest number of arrests occurred in South Florida where there were 59 suspects arrested.

The Justice Department reports that the defendants are accused of various 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 not isolated to Home Health.  They also involve mental health services, psychotherapy, physical and occupational therapy, durable medical equipment and ambulance services.


# of Individuals Involved

Alleged Fraud Total

Alleged Fraudulent Services

Miami, FL59 including three nurses and two therapists.  Two of these individuals were originally charged in April 2012 but were indicted on additional charges on 5/2/12.$137MHome Health Care, Mental Health Services, Occupational and Physical Therapy, DME and HIV infusion.
Baton Rouge, LA7 individuals$225MFalse claims for services
Detroit, MI22 including four Social Workers$58MHome Health, Psychotherapy and Infusion Therapy
Houston, TX9 including one physician and one nurse$16.4MHome Health Care & Ambulance Services
Los Angeles, CA8 including two doctors$14MDurable Medical Equipment (DME)
Chicago, IL1 individual$1MPsychotherapy Services
Tampa, FL1 PharmacistNot indicatedIllegal diversion of controlled substances

These cases are being prosecuted and investigated by multiple government agencies including, but not limited to, the Medicare Fraud Strike Force teams from the Fraud Section of the Justice Department’s Criminal Division and from the U.S. Attorneys’ Offices for the various states in which the crimes were alleged. Two such significant events in such a short space of time surely has to be sending a message to those that are committing fraudulent acts.  It’s disappointing that the system needs to have such a department exist.

Conversely we share this news and know that there are, literally, thousands of agencies doing all the right things for all of the right people. Continue to do what you’re doing. We appreciate you!

Content for this blog article was taken obtained from The United States Department of Justice Office of Public Affairs brief announced on May 2, 2012. For additional information please click here for their announcement.

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