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Medicare Fraud Strike Force charges 107 individuals for $452 million in false billing

May 4, 2012
by Patricia Sheehan
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A nationwide takedown by Medicare Fraud Strike Force operations in seven cities has resulted in charges against 107 individuals, including doctors, nurses and other licensed medical professionals, for their alleged participation in Medicare fraud schemes involving approximately $452 million in false billing, the U.S. Department of Health & Human Services announced on Wednesday.

The coordinated takedown involved the highest amount of false Medicare billings in a single takedown in Strike Force history.

HHS also suspended or took other administrative action against 52 providers following a data-driven analysis and credible allegations of fraud.

The joint Department of Justice and HHS Medicare Fraud Strike Force is a multi-agency team of federal, state and local investigators 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.

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 (including nursing home residents—some of whom were mentally ill) 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, healthcare company owners and others charged are accused of conspiring to submit a total of approximately $452 million in fraudulent billing.

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