Federal Bust Leads to 90 Arrests Across 6 Cities for Medicare Fraud
On Tuesday, May 13th, the Departments of Justice, and Health and Human Services, announced the arrests of 90 people in six cities across the US for Medicare fraud and false billing, which amounted to around $260 million.
The majority of the Medicare fraud arrests were centered in Miami, where 50 people were arrested for fraudulent billings for home health care, mental health, and pharmacy services, amounting to $65.5 million. One of the Miami cases involved $23 million in false billing and Medicare fraud, in which two suspects solicited a pharmacy owner for providing Medicare beneficiary information. The information was used to bill for prescriptions that were never dispensed.
Five other suspects, this time in Tampa, submitted the names of Miami-based Medicare beneficiaries, but the claims were for services allegedly performed in Tampa clinics, which is nearly 300 miles away.
“The crimes charged represent the face of health care fraud today,” Acting Assistant Attorney General David O’Neil said. “Doctors billing for services that were never rendered, supply companies providing motorized wheelchairs that were never needed, recruiters paying kickbacks to get Medicare billing numbers of patients.
“The fraud was rampant, it was brazen and it permeated every part of the Medicare system,” he said.
This is the 7th major Medicare fraud sweep conducted by the Medicare Fraud Strike Force since 2009. The task force was formed in 2007.
“Medicare is a sacred compact with our nation’s seniors, and to protect it, we must remain aggressive in combating fraud,” Attorney General Eric Holder said, adding that the arrests were necessary to “ensure the integrity of essential health care programs.”
Said HHS Secretary Kathleen Sebelius: “Today, we’re sending a strong, clear message to anyone seeking to defraud Medicare. You will get caught and you will pay the price …”
Of the 90 people arrested, 16 of the suspects are doctors, and five of them were based in the Houston, Texas area. Allegedly, those five doctors billed for “medically unnecessary” home health services. One Los Angeles-based doctor defrauded Medicare of $24 million for medical equipment, including 1,000 wheelchairs that were not only medically unnecessary, but frequently not provided to the patient.
Whistleblower Protections and Medicare Fraud Claims
“Qui Tam” are the first words of a Latin clause referring to the plaintiff as “one who sues as much for the state as for himself or herself.”
It is a provision of the Federal Civil False Claims Act that allows a private citizen to file a suit, in the name of the U.S. Government, charging fraud by government contractors and other entities that receive or use government funds. Bolstered by amendments passed by Congress in 1986, the law has armed private citizens who have independent and direct knowledge of fraud, whether financial institution fraud or Medicare fraud, with a weapon to prosecute government contractors and others who are defrauding the Government.
Common whistle blower actions include:
- Medicare fraud,
- defense contractor fraud, and
- other kinds of fraud against state or federal government
Qui tam lawsuits have been, and continue to be, a very effective and successful tool in combating government procurement and program fraud.
The Strom Law Firm Can Help Protect Medicare Fraud Whistleblowers with the False Claims Act
If you are personally aware of a fraud that has been committed by your current or former employer, a competitor or otherwise, from tax evasion to Medicare fraud, contact the Qui Tam attorneys at the Strom Law Firm today for a no cost consultation to discuss the facts of your case and whether filing a qui tam may be appropriate. We understand the complexity of the False Claims Act, and can help you with your case. We offer free, confidential consultations so contact us for help today. 803.252.4800