Biggest Medicaire Fraud Arrest in USA history

AG Loretta Lynch 

According to Wall Street Journal..."Federal agents have arrested roughly 300 suspects in what officials call their largest crackdown on Medicare fraud, with charges ranging from taking illegal payments for marketing medications to false physical-therapy claims.

Attorney General Loretta Lynch announced the crackdown Wednesday, citing cases around the country where prosecutors say they found a wide variety of health-care fraud that totaled about $900 million in losses.

In California, officials have charged a man with receiving illegal payments for marketing compound medications, the costs of which were paid by Tricare, a program for members of the military, veterans and their families.

Previously, authorities have said compound-prescription sales involving Tricare were generating hundreds of millions of dollars in fraudulent transactions. The medications are specially mixed by pharmacists, often to treat pain, and often sell for thousands of dollars per prescription.

Other suspects charged in the crackdown include the managers of physical-therapy clinics in New York City that allegedly laundered money, paid kickbacks and billed Medicare and Medicaid for unnecessary treatments for patients." See link here....http://www.wsj.com/articles/justice-department-announces-biggest-medicare-fraud-crackdown-1466609497

When you take from the piggy bank, it sometimes comes to bite you back. I also read in another news report that one doctor and his associates from South Texas billed medicaire for 38 million dollars in phony claims. Ouch. Expect a long sentence for that case. The justice story says the following,"Attorney General Loretta E. Lynch and Department of Health and Human Services (HHS) Secretary Sylvia Mathews Burwell announced today an unprecedented nationwide sweep led by the Medicare Fraud Strike Force in 36 federal districts, resulting in criminal and civil charges against 301 individuals, including 61 doctors, nurses and other licensed medical professionals, for their alleged participation in health care fraud schemes involving approximately $900 million in false billings.  Twenty-three state Medicaid Fraud Control Units also participated in today’s arrests.  In addition, the HHS Centers for Medicare & Medicaid Services (CMS) is suspending payment to a number of providers using its suspension authority provided in the Affordable Care Act.  This coordinated takedown is the largest in history, both in terms of the number of defendants charged and loss amount.  

Attorney General Lynch and Secretary Burwell were joined in the announcement by Assistant Attorney General Leslie R. Caldwell of the Justice Department’s Criminal Division, FBI Associate Deputy Director David Bowdich, Inspector General Daniel Levinson of the HHS Office of Inspector General (OIG), Acting Director Dermot O’Reilly of the Defense Criminal Investigative Service (DCIS), and Deputy Administrator and Director of CMS Center for Program Integrity Shantanu Agrawal M.D.

The defendants announced today are charged with various health care fraud-related crimes, including conspiracy to commit health care fraud, violations of the anti-kickback statutes, money laundering and aggravated identity theft.  The charges are based on a variety of alleged fraud schemes involving various medical treatments and services, including home health care, psychotherapy, physical and occupational therapy, durable medical equipment (DME) and prescription drugs.  More than 60 of the defendants arrested are charged with fraud related to the Medicare prescription drug benefit program known as Part D, which is the fastest-growing component of the Medicare program overall.

“As this takedown should make clear, health care fraud is not an abstract violation or benign offense – It is a serious crime,” said Attorney General Lynch.  “The wrongdoers that we pursue in these operations seek to use public funds for private enrichment.  They target real people – many of them in need of significant medical care.  They promise effective cures and therapies, but they provide none.  Above all, they abuse basic bonds of trust – between doctor and patient; between pharmacist and doctor; between taxpayer and government – and pervert them to their own ends.  The Department of Justice is determined to continue working to ensure that the American people know that their health care system works for them – and them alone.”

“Millions of seniors depend on Medicare for essential health coverage, and our action shows that this administration remains committed to cracking down on individuals who try to defraud the program,” said Secretary Burwell.  “We are continuing to put new tools and additional resources to work, including $350 million from the Affordable Care Act, for health care fraud prevention and enforcement efforts.  Thanks to the hard work of the Medicare Fraud Strike Force, we are making progress in addressing and deterring fraud and delivering results to help ensure Medicare remains strong for years to come.”

According to court documents, the defendants allegedly participated in schemes to submit claims to Medicare and Medicaid for treatments that were medically unnecessary and often never provided.  In many cases, patient recruiters, Medicare beneficiaries and other co-conspirators were allegedly paid cash kickbacks in return for supplying beneficiary information to providers, so that the providers could then submit fraudulent bills to Medicare for services that were medically unnecessary or never performed.  Collectively, the doctors, nurses, licensed medical professionals, health care company owners and others charged are accused of submitting a total of approximately $900 million in fraudulent billing.' 

What can they expect in federal prison? Will they all end up in jail? It all depends on the money in how much they stole. The more you steal from the system, the more time you spend in prison...

To read about federal prison, read my story..https://www.amazon.com/gp/product/B011GTWLOG