Federal prosecutors recently announced the conviction of the former office manager of a home healthcare company for conspiring to commit Medicare fraud. The case, which was brought as part of the Medicare Fraud Strike Force, demonstrates the way that federal government agencies coordinate through investigative partnerships to prosecute healthcare fraud. The defendant in the case, the manager of Mercy Home Care Inc. (Mercy) and a billing employee for D&D&D Home Health Care Inc. (DDD), was convicted following a two-week jury trial on charges that he conspired to commit health care fraud and wire fraud, as well as one count of conspiring to defraud the United States and pay and receive health care bribes and kickbacks.
According to prosecutors, evidence at trial showed that he and his co-conspirators used the companies to submit false claims to Medicare that were based on services that were not medically necessary, not actually provided and for patients that were procured through the payment of illegal kickbacks to doctors and patient recruiters. In an attempt to support the false claims, prosecutors claimed that the defendant’s co-conspirators forged prescriptions and other medical records, and that he submitted claims to Medicare based on the falsified documentation. All told, according to DOJ in its recent release, evidence produced at trial showed that Medicare paid nearly $2.5 million for false and fraudulent claims that were submitted by Mercy and DDD between October of 2014 and June of 2015.
Here’s a copy of the original indictment. It charged Leon and several co-conspirators with several specific criminal counts, including:
- conspiracy to commit health care fraud and wire fraud in violation of 18 U.S.C. 1349;
- health care fraud in violation of 18 U.S.C. 1347; payment of kickbacks in connection with a Federal Health Care Program in violation of 42 U.S.C. 1320a-7b(b)(2)(A); and
- conspiracy to defraud the United States and Pay and Receive Health Care Kickbacks in violation of 18 U.S.C. 371.
The last count—the general federal conspiracy charge—raised the following more specific allegations as part of the alleged general conspiracy:
[a violation of] Title 42, United States Code, Section 1320a-7b(b)(2)(A), by knowingly and willfully offering and paying remuneration, including kickbacks and bribes, directly and indirectly, overtly and covertly, in cash and in kind, to a person to induce such person to refer an individual to a person for the furnishing and arranging for the furnishing of any item and service for which payment may be made in whole and in part by a Federal health care program, that is, Medicare.
…
[a violation of] Title 42, United States Code, Section l320a-7b(b)(1)(A), by knowingly and willfully soliciting and receiving remuneration, including kickbacks and bribes, directly and indirectly, overtly and covertly, in cash and in kind, in return for referring an individual to a person for the furnishing and arranging for the furnishing of any item and service for which payment may be made in whole and in part by a Federal health care program, that is, Medicare.
Again, the case was brought as part of the Medicare Fraud Strike Force. The Medicare Fraud Strike Force has charged nearly 3,000 defendants with collectively billing the Medicare program for more than $11 billion since its inception. Medicare fraud continues to be a priority with the Department of Justice.
As described by the to the U.S. Department of Health and Human Services, the Medicare Fraud Strike Force:
Medicare Fraud Strike Force Teams harness data analytics and the combined resources of Federal, State, and local law enforcement entities to prevent and combat health care fraud, waste, and abuse. First established in March 2007, Strike Force teams currently operate in the following areas: Miami, Florida; Los Angeles, California; Detroit, Michigan; Houston, Texas; Brooklyn, New York; Baton Rouge and New Orleans, Louisiana; Tampa and Orlando, Florida; Chicago, Illinois; Dallas, Texas; Washington, D.C.; Newark, New Jersey/Philadelphia, Pennsylvania; and the Appalachian Region.
Strike Force teams work closely with the Office of Inspector General, the Department of Justice, Offices of the United States Attorneys, the Federal Bureau of Investigation, local law enforcement, and others.
For recent Medicare Fraud Strike Force activities:
February 21, 2020; Connecticut State Division of Criminal Justice Waterbury Woman Charged in Scheme to Defraud Medicaid
February 19, 2020; Connecticut State Division of Criminal Justice New Haven Woman Charged with Medicaid Fraud
February 6, 2020; Department of Justice Patient Recruiter Sentenced to Prison for Role in More than $1 Million Illegal Kickback Conspiracy
February 5, 2020; Department of Justice Two Owners of Telemedicine Companies Charged for Roles in $56 Million Conspiracy to Defraud Medicare and Receive Illegal Kickbacks in Exchange for Orders of Orthotic Braces
February 4, 2020; U.S. Department of Justice Four Detroit-Area Physicians Found Guilty of Health Care Fraud Charges for Role in Over $150 Million Health Care Fraud Scheme
January 17, 2020; State of Alaska Department of Law Anchorage Dentist Seth Lookhart Convicted of Medical Assistance Fraud, Illegal Practice of Dentistry, Reckless Endangerment
January 8, 2020; U.S. Department of Justice Philadelphia-Area Doctor Sentenced to 12 Months in Prison for Unlawfully Distributing Oxycodone
January 6, 2019; U.S. Department of Justice Former Los Angeles-Area Physician Sentenced to Two Years in Federal Prison for Defrauding Medicare and Illegally Prescribing Opioid Drugs
December 19, 2019; U.S. Department of Justice Owner of Detroit-Area Health Care Clinics Sentenced to Prison for a Diversion Scheme Involving 500,000 Pills of Oxycodone and Other Drugs
November 22, 2019; U.S. Department of Justice New Jersey/Pennsylvania Doctor Pleads Guilty to Accepting Bribes and Kickbacks In Exchange for Prescribing Powerful Fentanyl Drug
November 15, 2019; U.S. Department of Justice Head of New York Medical Clinics Found Guilty in Nearly $100 Million Money Laundering and Health Care Kickback Scheme
November 13, 2019; U.S. Department of Justice Owner of Detroit-Area Health Care Clinics Pleads Guilty to Drug Diversion Scheme
November 8, 2019; U.S. Department of Justice Insurance Broker Found Guilty of 22 Counts in $2 Million Scheme to Defraud Carefirst Bluecross Blueshield
November 6, 2019; U.S. Department of Justice Three Individuals, Including A Former Texas Mayor, CEO and Owner, Found Guilty in a $154 Million Money Laundering and Health Care Fraud Scheme
October 28, 2019; U.S. Department of Justice Detroit Home Health Owner Sentenced to Prison for Role in $1.5 Million Medicare Kickback Scheme
October 17, 2019; U.S. Department of Justice Southern California Doctor Found Guilty in $12 Million Medicare Fraud and Device Adulteration Scheme
October 7, 2019; U.S. Department of Justice Texas Physician Convicted in $16 Million Medicare Fraud Scheme
September 27, 2019; U.S. Department of Justice Midwest Health Care Fraud Law Enforcement Action Results in Charges Against 53 Individuals Alleging $250 Million in Loss
September 25, 2019; U.S. Department of Justice Florida and Georgia Health Care Fraud Law Enforcement Action Results in Charges against 67 Individuals
September 18, 2019; U.S. Department of Justice Charges Brought Against 34 Individuals for Alleged West Coast Medicare and Medicaid Fraud Schemes Totaling $258 Million
September 18, 2019; U.S. Department of Justice Owner of Detroit-Area Health Care Clinics Pleads Guilty to Drug Diversion Scheme
September 18, 2019; U.S. Attorney; Central District of California 25 Southern California Defendants Face Federal Charges Alleging Fraud Schemes that Cost Health Care Programs Millions of Dollars
September 16, 2019; U.S. Department of Justice Texas Hospital Administrator Sentenced to 10 Years in Prison for Role in $16 Million Health Care Fraud Scheme
September 13, 2019; U.S. Attorney; Southern District of Florida South Florida Health Care Facility Owner Sentenced To 20 Years in Prison for Role in Largest Health Care Fraud Scheme Ever Charged By the Department Of Justice
September 12, 2019; U.S. Department of Justice South Florida Health Care Facility Owner Sentenced to 20 Years in Prison for Role in Largest Health Care Fraud Scheme Ever Charged by The Department of Justice
September 12, 2019; U.S. Department of Justice New Jersey Doctor Pleads Guilty to $13 Million Conspiracy to Defraud Medicare with Telemedicine Orders of Orthotic Braces
September 6, 2019; U.S. Department of Justice Owner and Chief Executive Officer of Telemedicine Company Pleads Guilty to $424 Million Conspiracy to Defraud Medicare and Receive Illegal Kickbacks in Exchange for Orders of Durable Medical Equipment
September 5, 2019; U.S. Department of Justice New York Ambulette Company Owners Plead Guilty in More than $8.6 Million Health Care Kickback Scheme
August 29, 2019; U.S. Department of Justice Louisiana Physician’s Assistant Sentenced to Prison for Scheme to Unlawfully Distribute Controlled Substances
August 21, 2019; U.S. Department of Justice Two Los Angeles Pharmacy Owners Found Guilty in Multimillion-Dollar Health Care Fraud and Money Laundering Scheme
August 20, 2019; U.S. Attorney; Eastern District of Missouri Pharmacy Owner Sentenced for Health Care Fraud and Filing False Tax Returns
August 19, 2019; U.S. Department of Justice Nigerian Man Sentenced to Prison for Role in $8.3 Million Medicare Fraud Scheme and Related Money Laundering
July 30, 2019; U.S. Department of Justice Patient Recruiter Found Guilty in $1.3 Million Medicare Kickback Scheme
June 27, 2019; U.S. Department of Justice Owner of Tampa-Area Medical Marketing Company Found Guilty in $2 Million Medicare Fraud Scheme
June 20, 2019; U.S. Department of Justice Former Medical Director and Two Former Operators of a Houston Medical Clinic Charged in Multimillion-Dollar Health Care Fraud Scheme
June 13, 2019; U.S. Department of Justice South Florida Pill Mill Owner Sentenced to Prison for Role in $2.2 Million Medicare Fraud Scheme
June 11 2019; U.S. Department of Justice Owners of Los Angeles Home Health Agency Sentenced to Prison for Role in Health Care Fraud that Defrauded Medicare
June 6, 2019; U.S. Department of Justice Los Angeles Dentist Sentenced to 40 Months in Prison for Role in $3.8 Million Health Care Fraud Scheme
May 31, 2019; U.S. Department of Justice Co-Owners of Chicago-Area Home Health Agency Plead Guilty to Kickbacks Conspiracy Charges
May 31, 2019; U.S. Department of Justice Two Chicago Women Held Accountable for Falsely Billing 24-7 for Seven Years in $1.7 Million Workers’ Compensation Fraud
May 30, 2019; U.S. Department of Justice Mandeville, Louisiana Neurologist Pleads Guilty for Role in Scheme to Unlawfully Dispense Controlled Substances and to Commit Health Care Fraud
May 20, 2019; U.S. Department of Justice Michigan Doctor Pleads Guilty to Role in $2.5 Million Medicare Fraud Scheme
May 17, 2019; U.S. Department of Justice Baton Rouge Doctor Sentenced to Prison for Fraudulent Billing Scheme
May 8, 2019; U.S. Department of Justice New York Diagnostic Testing Facility Owners Plead Guilty in More than $18.5 Million Health Care Fraud Scheme
May 8, 2019; U.S. Department of Justice Nigerian Man Pleads Guilty to Role in $8.3 Million Medicare Fraud Scheme and Related Money Laundering
May 8, 2019; U.S. Department of Justice South Florida Patient Recruiter Sentenced for Role In $1.6 Million Kickback Scheme
April 30, 2019; U.S. Department of Justice Owner of Florida Medical Clinic Sentenced to Prison
April 22, 2019; U.S. Department of JusticeMichigan Home Health Agency Owner Sentenced to Prison for $8.3 Million Medicare Fraud
April 9, 2019; U.S. Department of Justice Federal Indictments & Law Enforcement Actions in One of the Largest Health Care Fraud Schemes Involving Telemedicine and Durable Medical Equipment Marketing Executives Results in Charges Against 24 Individuals Responsible for Over $1.2 Billion in Losses
April 5, 2019; U.S. Department of Justice South Florida Health Care Facility Owner Convicted for Role in Largest Health Care Fraud Scheme Ever Charged by The Department of Justice, Involving $1.3 Billion in Fraudulent Claims
April 4, 2019; U.S. Department of Justice Former CEO of Tennessee Pain Management Company Convicted for Role in Approximate $4 Million Medicare Kickback Scheme
April 4, 2019; U.S. Department of Justice Former Administrator of Two Houston Home Health Companies Sentenced to Prison in $20 Million Medicare Fraud Scheme
April 2, 2019; U.S. Department of Justice Dallas-Area Home Health Care Employee Sentenced to Five Years in Prison for His Role in a $3.7 Million Health Care Fraud Scheme
March 28, 2019; U.S. Department of Justice Chicago Home Health Company Owner Convicted for Role in $3 Million Kickback Scheme
March 19, 2019; U.S. Department of Justice Florida Pharmacist Sentenced to 10 Years in Prison for $100 Million Compounding Pharmacy Fraud Scheme Eight Others Previously Sentenced
March 19, 2019; U.S. Department of Justice Louisiana-Based Licensed Clinical Social Worker Pleads Guilty to Medicaid Fraud Scheme
March 13, 2019; U.S. Department of Justice Creator of Fraudulent Chicago-Area Pharmacy Sentenced to Five Years in Prison for $1.6 Million Fraud Scheme
March 13, 2019; U.S. Department of Justice Philadelphia-Area Doctor Pleads Guilty to Unlawfully Distributing Oxycodone
March 13, 2019; U.S. Department of Justice Owner of Washington, D.C.-Based Durable Medical Equipment Company Sentenced to Prison for Role in $9.8 Million Medicaid Fraud Scheme
February 27, 2019; U.S. Department of Justice Florida Home Health Services Company Owner and Co-Conspirator Sentenced to Prison for Role in $8.6 Million Health Care Fraud Scheme
February 25, 2019; U.S. Department of Justice Southern California Pharmacy Owner Sentenced to Prison for Her Role in Health Care and Wire Fraud Scheme
February 22, 2019; U.S. Department of Justice South Florida Patient Recruiter Convicted For Role In $600,000 Health Care Kickback Scheme
February 15, 2019; U.S. Department of Justice Michigan Patient Recruiter Pleads Guilty in $1.2 Million Kickback Scheme
February 14, 2019; U.S. Department of Justice Baton Rouge Doctor and His Medical Billing Supervisor Plead Guilty to Fraudulent Billing Scheme
December 19, 2018; U.S. Department of Justice Eight Dallas-Area Pharmacy Owners and Marketers Charged in $9 Million Kickback Scheme
December 18, 2018; U.S. Department of Justice Miami-Area Pharmacy Owner Sentenced to Over Seven Years in Prison for Role in $8.4 Million Medicare Fraud Scheme
December 17, 2018; U.S. Department of Justice Miami-Area Woman Sentenced to Over Six Years in Prison for Role in $4.65 Million Medicare Fraud Scheme
December 14, 2018; U.S. Department of Justice Pharmacy Owner Convicted in Medicare Fraud Scheme
December 7, 2018; U.S. Department of Justice South Florida Pharmacy Owner Sentenced to Almost Four Years in Prison for Role in $2.5 Million Medicare Fraud Scheme
December 7, 2018; U.S. Attorney; Eastern District of Virginia Former Owner of Sleep Study Businesses Sentenced for Fraud
December 4, 2018; U.S. Department of Justice Florida Home Health Services Company Owner and Co-Conspirator Plead Guilty for Roles in $8.6 Million Health Care Fraud Scheme
November 21, 2018; U.S. Department of Justice Two Dallas Area Clinic Workers Charged in $5.9 Million Health Care Fraud Scheme
November 20, 2018; U.S. Department of Justice Louisiana Doctor Pleads Guilty to Conspiring to Receive Health Care Kickback Payments
November 14, 2018; U.S. Department of Justice Detroit Clinic Owner Sentenced to Over 13 Years in Prison for $8.9 Million Health Care Fraud Scheme
November 7, 2018; U.S. Department of Justice Co-Owners of Miami Pain Management Clinic and Patient Recruiter Sentenced to Prison for Scheme to Distribute Medically Unnecessary Opioid Prescriptions
November 5, 2018; U.S. Department of Justice Patient Recruiter Convicted in $1.1 Million Kickback Scheme
October 30, 2018; U.S. Department of Justice Two Home Health Agency Owners and Two Employees Convicted for Roles in $3.7 Million Home Health Fraud Scheme
October 18, 2018; U.S. Department of Justice Two Michigan Home Health Agency Owners Sentenced to Prison for Health Care Fraud
October 16, 2018; U.S. Department of Justice Dallas Physicians and Nurses Sentenced to Prison for Role in $11 Million Medicare Fraud Scheme
October 15, 2018; U.S. Department of Justice Health Care CEO Pleads Guilty to $150 Million Health Care Fraud Scheme Involving Harmful Injections and Unnecessary Prescription of Millions of Opioids
October 15, 2018; U.S. Attorney; Northern District of Iowa Iowa Nurse Who Took Pain Medications from Nursing Home Patients Pleads Guilty
October 9, 2018; U.S. Department of Justice Texas Hospital Administrator Convicted of Health Care Fraud for Role in $16 Million Medicare Fraud Scheme
October 9, 2018; U.S. Department of Justice Miami-Area Pharmacy Owner Pleads Guilty for Role in $8.4 Million Medicare Fraud Scheme
October 4, 2018; U.S. Department of Justice Texas Patient Recruiter Sentenced to Nine Years in Prison for $3.6 Million Home Health Care Fraud Scheme
September 27, 2018; U.S. Department of Justice Detroit Doctor Sentenced to more than 11 Years in Prison for $8.9 Million Health Care Fraud Scheme
September 19, 2018; U.S. Department of Justice Physician and Two Clinic Operators Found Guilty for Their Roles in $17 Million Medicare Fraud Scheme
August 28, 2018; U.S. Department of Justice Co-Owners of Miami Pain Management Clinic Plead Guilty to Conspiracy to Distribute Medically Unnecessary Opioid Prescriptions
August 23, 2018; U.S. Department of Justice California Doctor Convicted of Medicare Kickback Conspiracy
June 15, 2018; U.S. Department of Justice Nurse Practitioner Pleads Guilty in Compounding Pharmacy Fraud Scheme
June 7, 2018; U.S. Department of Justice Mississippi Physician Sentenced to Over Three Years in Prison for Role in $3 Million Compounding Pharmacy Fraud Scheme
June 7, 2018; U.S. Attorney; Middle District of Alabama Former Chief Executive Officer of Health Care Company Charged with Giving Kickbacks to Pill Mill Doctor, Health Care Fraud, and Money Laundering
June 6, 2018; U.S. Department of Justice Health Care CEO and Four Physicians Charged in Superseding Indictment in Connection with $200 Million Health Care Fraud Scheme Involving Unnecessary Prescription of Controlled Substances and Harmful Injections
May 25, 2018; U.S. Department of Justice Doctor Convicted in $8.9 Million Health Care Fraud Scheme
May 17, 2018; U.S. Department of Justice Michigan Home Health Agency Owner Pleads Guilty to Health Care Fraud Charges for Role in $8 Million Medicare Fraud Scheme
May 2, 2018; U.S. Department of Justice Southern Texas Patient Recruiter Convicted in $3.6 Million Home Health Care Fraud Scheme
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