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.

To learn more about HEAT, go to: www.stopmedicarefraud.gov.

Secretary Sebelius Statement on the 40th Anniversary of the Passage of Title IX

FOR IMMEDIATE RELEASE
June 21, 2012
Contact: OASH Press Office
(202) 205-0143

Saturday, June 23rd marks the 40th anniversary of Title IX of the Education Amendments of 1972, which prohibits gender discrimination in all areas of education. Title IX is best known for establishing greater opportunities for women and girls to play competitive sports at all academic levels.

Since the passage of Title IX, the number of girls who compete in high school sports has grown ten-fold—from fewer than 300,000 in 1972 to over three million in 2011. Moreover, collegiate athletic programs experienced a six-fold increase in the number of female athletes over the past 40 years. The number of young males playing sports has also increased as a result of Title IX, as more opportunities have been made available at all levels of play.

Despite the many important advancements spurred by Title IX, our nation still has a long way to go before female athletes compete on a level playing field with males. Unequal access, financial assistance and treatment for girls and women in sports still exist in too many communities and educational institutions, and these disparities are often more prevalent among minority and underserved populations, including people with disabilities.

The availability of athletic scholarships dramatically increases a young woman’s ability to pursue a college education and to choose from a wider range of colleges and universities. We also know that competitive sports programs promote greater academic and employment success, improved personal skills and a variety of health benefits for women and girls. Unfortunately girls and women still have fewer opportunities to participate in school sports than their male counterparts, and female athletes still do not receive an equal share of athletic scholarship dollars.

Legendary civil rights leader and tennis champion, Billie Jean King, is one of the most outspoken advocates of Title IX and educational institutions’ full adherence to the law. We are proud to have Billie Jean as a member of the President’s Council on Fitness, Sports & Nutrition. Her unparalleled accomplishments, and her dedication to promoting the myriad benefits of Title IX, are an ongoing reminder of the importance of achieving gender equity in all parts of our society.

To learn more about the Title IX, visit www.fitness.gov.

Repealing Health Care Reform Would Also Repeal Medicare Fraud Tools

FOR IMMEDIATE RELEASE
April 4, 2012
Contact: HHS
HHS Press Office

HHS, Department of Justice highlight Obama administration efforts —
Health Reform tools to combat Medicare fraud

 HHS Secretary and Attorney General host seventh Regional Health Care Fraud Prevention Summit in Chicago

At a Chicago summit highlighting a new high-tech war against health care fraud, Health and Human Services (HHS) Secretary Kathleen Sebelius and Attorney General Eric Holder today discussed how the Affordable Care Act and the Obama administration’s Health Care Fraud Prevention and Enforcement Action Team (HEAT) are helping fight Medicare fraud.  The Chicago summit is the seventh regional health care fraud prevention summit hosted by the Department of Justice and HHS.

The regional summits bring together a wide array of public and private partners, and are part of the HEAT partnership between HHS and the Department of Justice to prevent and combat health care fraud.  The Obama administration’s HEAT efforts have resulted in record-breaking health care fraud recoveries.  In fiscal year 2011, for the second year in a row, the departments’ anti-fraud activities resulted in more than $4 billion in recoveries, an all-time high.

“We have a simple message to criminals thinking about committing Medicare fraud: don’t even try,” said Secretary Sebelius. “Thanks to health reform and our administration’s work, we have new tools and resources to catch criminals and stop Medicare fraud before it happens.”

“This Administration continues to move aggressively in protecting patients and consumers and bringing health care fraud criminals to justice,” said Attorney General Holder.  “Through HEAT, we have achieved unprecedented, record-breaking successes in combating health care fraud and as a result of the Affordable Care Act, we have additional critical resources, tools and authorities to continue this great success.”

New tools provided by the Affordable Care Act are strengthening the Obama administration’s efforts to fight health care fraud.  As a result of Affordable Care Act provisions:

  • Criminals face tougher sentences for health care fraud, 20-50 percent longer for crimes that involve more than $1 million in losses;
  • Contractors that police Medicare for waste, fraud, and abuse will expand their work to Medicaid, Medicare Advantage, and Medicare Part D programs;
  • Government entities, including states, the Centers for Medicare & Medicaid Services (CMS), and law enforcement partners at the Office of the Inspector General (OIG) and DOJ, have greater abilities to work together and share information so that CMS can prevent money from going to bad actors by using its authority to suspend payments to providers and suppliers engaged in suspected fraudulent activity.

Increased collaboration has yielded significant results through the HEAT partnership.  Since the creation of HEAT in 2009, the Medicare Fraud Strike Force operations have expanded from two to nine locations throughout the United States, including Chicago.  Strike Force operations expanded to Chicago in February 2011 and since that time, charges have been filed against more than 35 defendants in the Northern District of Illinois for offenses related to health care fraud.  Overall, in fiscal year 2011, strike force operations in nine locations charged a total of more than 320 defendants for allegedly billing more than $1 billion in false claims.

In February, as a result of HEAT and strike force actions, a Dallas-area physician and the office manager of his medical practice, along with five owners of home health agencies, were arrested on charges related to their alleged participation in a nearly $375 million health care scheme involving fraudulent claims for home health services.  In conjunction with this action, CMS imposed payment suspensions against 78 home health agencies in the Dallas area.

Today, the Obama administration also announced more progress from its anti-fraud efforts, beyond the nearly $4.1 billion recovered last year:

  • In the early phase of revalidating the enrollment of providers in Medicare, 234 providers were removed from the program because they were deceased, debarred or excluded by other federal agencies, or were found to be in false storefronts or otherwise invalid business locations;
  • In 2011, HHS revoked 4,850 Medicaid providers and suppliers and deactivated 56,733 Medicare providers and suppliers as it took steps to close vulnerabilities in Medicare;
  • In 2011, HHS saved $208 million through pre-payment edits that stop implausible claims before they are paid;
  • Prosecutions are up: the number of individuals charged with fraud increased from 797 in fiscal year 2008 to 1,430 in fiscal 2011 – nearly a 75 percent increase;
  • In the first few weeks of enhanced site visits required under the ACA screening requirements, HHS found 15 providers and suppliers whose business locations were non-operational and terminated their billing privileges;
  • Through outreach and engagement efforts more than 49,000 complaints of fraud from seniors and people with disabilities reported to 1-800-MEDICARE were referred for further evaluation;
  • A recent re-design of the quarterly Medicare Summary Notices received by Medicare beneficiaries makes it easier to spot and report fraud.

See this fact sheet for additional details about the Obama administration’s efforts to combat health care fraud.

Twisting a Rite to Deny Rights

Yesterday, presidential candidate Mitt Romney blasted the ruling put forth by the 9th Circuit Court of Appeals:

“Today, unelected judges cast aside the will of the people of California who voted to protect traditional marriage,” Romney said. “This decision does not end this fight, and I expect it to go to the Supreme Court. That prospect underscores the vital importance of this election and the movement to preserve our values. I believe marriage is between a man and a woman and, as president, I will protect traditional marriage and appoint judges who interpret the Constitution as it is written and not according to their own politics and prejudices.”

And like Romney, conservative media pundits piled thickly on that theme claiming the court had “no” right to overturn a majority of the voters. Excuse me? Apparently conservatives believe that if a majority of Americans voted to say that black Americans had no right to vote, or that women had no rights to property that would be acceptable to them as well?

I’m sorry Mr. Romney, but I agree with the 2-1 ruling of the Circuit Court Panel which said, “Proposition 8 served no purpose, and had no effect, other than to lessen the status and human dignity of gays and lesbians in California.” Proposition 8 may have been approved by 52% of California’s voters, but a majority vote should never be the standard for denying equality of rights to any of American’s citizens. “Proposition 8 served no purpose and had not effect, other ban to lessen the status and human dignity of gays-and-lesbians, in California.” As such, the Panel declared Proposition “unconstitutional” under the U.S. Constitution.

The whole issue of “marriage” is a tricky thing. If marriage were just a religious rite, that would be one thing, but marriage goes far beyond just a religious rite. Marriage is a legal construct recognized within our tax code that bestows beneficial tax privileges to such couples, not just annually, in terms of what couples jointly are required to pay, but in terms of property inheritance rights as well. There are also other legal ramifications relative to who can or cannot speak for your interests when you’re incapacitated, and even who might be handed this country’s flag when one’s partner makes the ultimate sacrifice for this country.  Denying the right to marry to gay and lesbian couples legalizes discrimination against them in the following ways:

  • Denying more preferential “joint income” tax rates by the IRS and state taxing authorities
  • Denying them the ability to create “family partnerships” which would allow them to divide their small business income amongst family members
  • Denying them the ability to “inherit” a share of a spouse’s estate without tax consequence.
  • Denying them any exemptions from estate and gift taxes
  • Denying them the ability to set up estate trusts that are restricted to just “married” couples
  • Denying them priority in being appointed as a “conservator” for your partner’s (spouse’s) affairs when he/she is incapacitated
  • Denying them the ability to obtain spousal benefits under government Social Security, Medicare, or disability programs
  • Denying them the ability to obtain veterans/military benefits as spouses
  • Denying them the ability to draw spousal retirement plan benefits as the spouse of the deceased plan member
  • Denying them the ability to take bereavement leave for the death of their partner (spouse).
  • Denying them the ability to be considered as “immediate family” for purposes of being able to visit in an ICU
  • Need I go on?

Gay and Lesbian couples had been given, by law, the right to marry. Then in 2008, a majority of voters participating in the 2008 election decided they wanted to take that fundamental, given right away for no reasonable and necessary reason. In addition, it would have “legalized” discrimination in terms of taxation and other allowable rights against an entire class of people in our society. If we permit this type of discrimination and taking of rights for this one class of citizens, who or what is next? How long would it take for our nation to approach they type of tyranny that was every present in pre-WWII Nazi Germany where millions of it’s citizens were ultimately condemned and went up in the smoke of a large number of incinerators.

Well, Mr. Romney, who’s the Nazi now?

Read more about the Rights and Benefits of Marriage the Right wants to deny to Same-Sex couples here