A Focus on Healthcare Fraud

In Fraud, White Collar by Jason B. Freeman2 Comments

A Focus on Healthcare Fraud

Federal prosecutors recently announced the conviction of the former office manager of a home health care 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 health care 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 a map of Strike Force Locations: Map of Strike Force Locations.

 

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

Comments

  1. We have always been skeptical of the doctors who order unnecessary tests to line their pockets. Now we learn of them billing Medicaid for tests that aren’t even being performed? And we wonder why healthcare costs are on the rise.

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