Entries in medicare (5)


107 Charged in Medicare Fraud Worth $452 Million

Official White House Photo by Pete Souza(WASHINGTON) -- Government officials Wednesday confirmed the arrests of more than 100 medical professionals in a nationwide crackdown on Medicare fraud. The Medicare Fraud Strike Force has charged 107 individuals around the country with about $452 million in false billings. Federal officials call that dollar amount the largest Medicare fraud bust in the five-year history of the Force.  

Suspects were rounded up in seven different cities Tuesday, including Los Angeles, Chicago, Miami, and Houston.

"The defendants charged include doctors, nurses, social workers, health care company owners and others, who are accused of a range of serious offenses," U.S. Attorney General Eric Holder said Wednesday at a news conference.

Federal authorities allege that medical service companies billed Medicare for services that were often unnecessary or never provided.

"We have charged owners and operators of four ambulance and private ambulance companies with billing Medicare for millions of dollars worth of phony or unnecessary ambulance rides," Assistant Attorney General Lanny Breuer said of the individuals charged in Texas.

In Baton Rouge, La., Breuer says seven defendants have been charged with running two community mental health clinics that submitted $225 million in fraudulent Medicare claims.

"These defendants allegedly recruited elderly, drug-addicted and mentally ill patients from nursing homes and homeless shelters in order to submit false claims on their behalf."

Holder touted the takedown as a result of the administration's commitment to keeping health care costs low for American taxpayers.

"The results war are announcing today are at the heart of an adminstration-wide commitment to protecting American taxpayers from health care fraud, which can drive up costs and threaten the strength and integrity of our health care system," he said, adding, "As today's takedown reflects, our ongoing fight against health care fraud has never been more coordinated and effective."

The Medicare Fraud Strike Force has charged more than 1,330 individuals for Medicare fraud totaling $4 billion since the initiative began in 2007.

Copyright 2012 ABC News Radio


Biggest Medicare Fraud in History Busted, Say Feds

Photodisc/Digital Vision/Thinkstock(WASHINGTON) -- Federal officials say they have taken down the largest Medicare fraud scheme investigators have ever discovered: a $375 million dollar home healthcare scam operating in the Dallas, Texas area.

The alleged "mastermind" of the fraud, Dr. Jacques Roy, is charged with certifying hundreds of fraudulent claims for Medicare reimbursement and pocketing millions in payments for services not needed, or never delivered.  Prosecutors say the 54-year-old Dr. Roy, who was arrested on Tuesday and could be sentenced to life in prison, operated a "boiler room" to churn out thousands of phony Medicare claims and recruited homeless people as fake patients.

"Today, the Medicare Fraud Strike Force is taking aim at the largest alleged home health fraud scheme ever committed," said Assistant Attorney General Lanny Breuer.  "According to the indictment, Dr. Roy and his co-conspirators, for years, ran a well-oiled fraudulent enterprise in the Dallas area, making millions by recruiting thousands of patients for unnecessary services, and billing Medicare for those services."

The government charges that Dr. Roy was planning to take the money and run.  He allegedly hid much of his Medicare money in an offshore account in the Cayman Islands. In documents filed in court Tuesday, the government charges that Dr. Roy was planning to change his identity and flee the country to avoid prosecution.  In a motion opposing bail for Dr. Roy, prosecutors claim that he had created a false Canadian identity under the name Michel Poulin, had a copy of a book called Hide Your A$$ET$ and Disappear, and a guide to yacht registration in the Caymans.

Dr. Roy's scam was clever, wide-ranging, and very profitable, according to prosecutors.  He allegedly exploited the Medicare regulation that requires a doctor to "certify" that Medicare services are legitimate -- that they are needed and are being delivered to the patient.  Dr. Roy allegedly sold his certification as "a commodity" to nearly 500 home health care companies in Texas, certifying patients for Medicare services regardless of whether they needed them or received them.  In return, the government charges, Dr. Roy would receive a portion of the fraudulent Medicare payment.

Between 2006 and 2011, according to the 13-count indictment unsealed on Tuesday, Dr. Roy certified more Medicare beneficiaries for home health services and had more patients, than any other medical practice in the United States.  He allegedly even had a "boiler room" where employees worked all day signing his name on Medicare claims.  Roy's company, Medistat Group and Associates, received hundreds of claims per day, and Dr. Roy allegedly instructed employees in the company's "485 Department," named for the "Plan of Care" form, to sign his name by hand or affix his electronic signature.

Since 2006, according to prosecutors, Medistat Group and Associates has "certified more than 11,000 unique patients from over 500 home healthcare agencies in the Dallas-Fort Worth area."  Medistat and the home health care agencies billed Medicare for more than $350 million and Medicaid for more than $24 million for these patients.

Seventy-eight companies associated with Dr. Roy will have their Medicare eligibility suspended immediately as a result of this indictment, the Justice Department says, and six associates of Dr. Roy's alleged scheme were also charged as co-conspirators.  Operating under the company names Apple of Your Eye, Ultimate Care and Charry Home Care, among others, the associates allegedly fed a steady stream of fraudulent clients to Dr. Roy to be certified as Medicare eligible.

In some cases, the indictment charges, Medicare patients were recruited by offering cash and groceries in return for signing up for home health care.  These fraudulent "patients" were then allegedly certified by Dr. Roy for services.  Some of those recruits didn't even have a home to visit, according to sources close to the investigation: they were recruited from homeless shelters.

For example, the indictment charges that Charity Eleda of Charry Home Health services "visited The Bridge Homeless Shelter" in Dallas to recruit Medicare patients.  She allegedly sat in a parked vehicle outside the shelter, and hired recruiters to send prospects to her car.  She allegedly paid the recruiters $50 per new "patient."

"Any treatment that Charity Eleda provided was either in her vehicle, in the courtyard of the Bridge, or on a park bench," said the indictment.

Dr. Roy's business manager, identified in the indictment as J.A., allegedly recorded phone calls with Dr. Roy in which he objected to working with the coconspirators to drum up phony business, and suggested that the company "invest in legitimate marketing" to attract business instead.  According to the indictment, Dr. Roy responded, "I've done enough marketing to know it's b___sh__, and I don't want to do it."

Federal sources say investigators have been looking into Dr. Roy's operation for years. In fact, he was suspended from the Medicare program in 2011.  But according to documents filed on Tuesday, Dr. Roy found a way around the suspension by creating a new company, "Medcare HouseCalls," and working through his associated companies.

Last summer, investigators searched his home and found evidence that Dr. Roy had stashed some of money he alleged stole from Medicare in a secret account in the Cayman Islands.  There was also evidence that Dr. Roy had created a false identity for himself -- he had a fake driver's license and a birth certificate in the name of Michel Poulin, and applications for Canadian citizenship.

Investigators also found bank deposit slips from Cayman Island banks, a guide to yacht registration in the Caymans, a book titled Hide Your A$$et$ and Disappear: A Step by Step Guide to Vanishing Without A Trace, and a copy of The Offshore Money Manual.

Copyright 2012 ABC News Radio


Doctors, Nurses, Therapists Arrested in Medicare Fraud Raids

Photo Courtesy - Getty Images(WASHINGTON) -- Federal agents raided health care facilities in nine states Thursday morning, arresting dozens of suspects believed to be defrauding Medicare of tens of millions of dollars.

Federal authorities say this is one of the largest -- if not the largest -- take-down of Medicare fraud suspects ever conducted.

The raids began Thursday morning in the pre-dawn hours.  The targets: more than 100 doctors, nurses, therapists and healthcare company executives who have allegedly been stealing tax dollars to the tune of $200 million in recent months.  Much of the fraud involved healthcare professionals billing the government for medical services never performed and medicines not provided.

The raids were conducted in Miami, Brooklyn, Tampa, Chicago, Baton Rouge, Houston, Dallas, and Los Angeles.

Ten individuals, including three doctors and one physical therapist, were charged in Brooklyn, New York with fraud schemes involving $90 million in false billings for physical therapy, proctology services and nerve conduction tests.

In Miami, 32 defendants, including two doctors and eight nurses, were charged for their participation in various fraud schemes involving a total of $55 million in false billings for home health care, durable medical equipment and prescription drugs.

Twenty-one defendants, including three doctors, three physical therapists and one occupational therapist, were charged in Detroit for schemes to defraud Medicare of more than $23 million.  The Detroit cases involve false claims for home health care, nerve conduction tests, psychotherapy, physical therapy and podiatry.

Ten defendants were charged in Tampa, Florida, for participating in schemes involving more than $5 million related to false claims for physical therapy, durable medical equipment and pharmaceuticals.  Nine individuals were charged in Houston for schemes involving $8 million in fraudulent Medicare claims for physical therapy, durable medical equipment, home health care and chiropractor services.

In Dallas, seven defendants were indicted for conspiring to submit $2.8 million in false billing to Medicare related to durable medical equipment and home health care.  Five defendants were charged in Los Angeles for their roles in schemes to defraud Medicare of more than $28 million.  The cases in Los Angeles involve false claims for durable medical equipment and home health care.

In Baton Rouge, Louisiana, six individuals were charged for a durable medical equipment fraud scheme involving more than $9 million in false claims.  In Chicago, charges were filed against 11 individuals associated with businesses that have billed Medicare more than $6 million for home health, diagnostic testing and prescription drugs.

Copyright 2011 ABC News Radio


Can Politicians Cut the Nation's $1.3 Trillion Deficit?

Photo Courtesy - Getty Images(WASHINGTON) -- Though the U.S. staggers with a $1.3 trillion budget deficit and a $13.8 trillion national debt, there is little political will and public support to tackle the issue.

President Obama's National Commission on Fiscal Responsibility and Reform will release a report Wednesday that outlines bold and oft controversial steps to reduce the debt that currently amounts to more than $44,300 for each American man, woman or child.

Yet with all of the talk of deficit reduction and paying down the debt, Congress continues to pass legislation that will add to the total, and analysts say both parties are to blame.

The Medicare "doc fix," for example, which passed Congress Monday and postpones for a month a 23 percent pay cut to doctors who participate in the Medicare program, will cost U.S. taxpayers $1 billion over 10 years.

The food safety bill that sailed through the Senate Tuesday, mainly on Democratic votes, is estimated to cost about $1.4 billion over four years.

The Republicans' tax proposal, which would extend Bush-era tax cuts for all Americans, regardless of income, would add $4 trillion to the deficit in the next decade, or $2.65 trillion without counting the alternative minimum tax.  President Obama and Democrats' proposal to extend tax cuts for only lower and middle-class Americans would add to the deficit by $2.15 trillion.

"I think they (lawmakers) are taking away with one hand what they're talking about doing with the other.  In fact, they aren't doing anything at the moment to reduce the deficit," said Isabel V. Sawhill, a budget expert at the Brookings Institute.  "They're just talking about it and what they're actually doing is stuff that's going to make matters worse and dig the hole deeper."

Copyright 2010 ABC News Radio


Largest Medicare Fraud Case Ever Brought Against One Criminal Enterprise

Photo Courtesy - Getty Images(WASHINGTON) -- Seventy-three defendants, including a number of alleged members and associates of an Armenian-American organized crime enterprise, were charged in indictments unsealed Wednesday in five judicial districts with various health care fraud-related crimes involving more than $163 million in fraudulent billing, announced Acting Deputy Attorney General Gary G. Grindler, FBI Assistant Director of the Criminal Investigative Division Kevin Perkins and Health and Human Services Inspector General Daniel R. Levinson.

In this national, multi-agency investigation, 52 people were arrested Wednesday by FBI agents in the largest Medicare fraud scheme ever perpetrated by a single criminal enterprise and charged by the Department of Justice.

The defendants are charged with engaging in numerous fraud activities, including highly-organized, multi-million dollar schemes to defraud Medicare and insurance companies by submitting fraudulent bills for medically unnecessary treatments or treatments that were never performed.  According to the indictments, the defendants allegedly stole the identities of doctors and thousands of Medicare beneficiaries and operated at least 118 different phony clinics in 25 states for the purposes of submitting Medicare reimbursements.

“The emergence of international organized crime in domestic health care fraud schemes signals a dangerous expansion that poses a serious threat to consumers as these syndicates are willing to exploit almost any program, business or individual to earn an illegal profit,” said Acting Deputy Attorney General Gary G. Grinder. “The Department of Justice is confronting this evolving threat here and abroad through a number of initiatives including a strengthened Attorney General’s Organized Crime Council and the creation of the International Organized Crime Intelligence and Operations Center (IOC-2) to ensure that we are focused and coordinated in our efforts to combat international organized crime.”

“The international organized crime enterprise known as the Mirzoyan-Terdjanian, fleeced the health care system through a wide-range of money making criminal fraud schemes.  The members and associates located throughout the United States and in Armenia, perpetrated a large-scale, nationwide Medicare scam that fraudulently billed Medicare for more than $100 million of unnecessary medical treatments using a series of phantom clinics,” said Kevin Perkins, FBI Assistant Director of the Criminal Investigative Division.  “We want to restore the confidence in the nation’s health care system and assure practitioners we will not stand by and let their identities be used for criminal gain.”  

Copyright 2010 ABC News

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