Late last week, a record 111 doctors, nurses, and healthcare professionals were rounded up and charged with various schemes involving false claims to Medicare and Medicaid for home health care, physical and occupational therapy, nerve conduction tests, podiatry, proctology, and durable medical equipment.

“With this takedown, we have identified and shut down large-scale fraud schemes operating throughout the country.   We have safeguarded precious taxpayer dollars.   And we have helped to protect our nation’s most essential health care programs, Medicare and Medicaid,” said Attorney General Holder.   “As today’s arrests prove, we are waging an aggressive fight against health care fraud.”

Health and Human Services Secretary Kathleen Sebelius lauded the return on investment spent on the joint partnership of DoJ and HHS in pursuing healthcare fraud investigations. “Last year alone, our partnership recovered a record $4 billion on behalf of taxpayers.  From 2008-2010, every dollar the Federal Government spent under its Health Care Fraud and Abuse Control programs averaged a return on investment of $6.80.”

The charges in last week’s healthcare fraud takedown ranged from conspiracy, criminal false claims, and kickbacks to money laundering and aggravated identity theft.  The arrests occurred primarily in metro areas across the country and were grouped and summarized by DoJ based on geography:

In Miami, 32 defendants, including 2 doctors and 8 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.

In Brooklyn, N.Y., 10 individuals, including three doctors and one physical therapist, were charged with fraud schemes involving $90 million in false billings for physical therapy, proctology services and nerve conduction tests.   Ten defendants were charged in Tampa 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, La., 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.

The combined total of the alleged fraud is estimated at over $225M. Under the federal False Claims Act, people with credible, first-hand knowledge of Medicare or Medicaid fraud stand to receive an award of as much as 25% (and in some cases 30%) of the total amount of any fraud recovery, which may consist of three times the actual damages.

To report Medicare or Medicaid fraud, contract Frohsin & Barger.