Feds Charge 90 With Health Fraud in Latest Strike Force Takedown

A nationwide takedown by Medicare Fraud Strike Force operations in six cities has resulted in charges against 90 individuals, including 27 doctors, nurses, and other medical professionals, for their alleged participation in Medicare fraud schemes involving approximately $260 million in false billings. The coordinated takedown is the seventh national Medicare fraud takedown in strike force history. Strike force operations are part of the Health Care Fraud Prevention and Enforcement Action Team, a joint initiative announced in May 2009 between the Department of Justice and the Department of Health and Human Services (HHS) to focus their efforts to prevent and deter fraud and enforce current anti-fraud laws around the country. Since its inception in March 2007, strike force operations in nine locations have charged almost 1,900 defendants who collectively have falsely billed the Medicare program for almost $6 billion. In addition, the Centers for Medicare and Medicaid Services, working in conjunction with HHS Office of Inspector General, has suspended enrollments of high-risk providers in five strike force locations and has removed over 17,000 providers from the Medicare program since 2011. The defendants are accused of various health care fraud-related crimes, including conspiracy to commit health care fraud, violations of the anti-kickback statutes, and money laundering. The charges are based on a variety of alleged fraud schemes involving various medical treatments and services, including home health care, mental health services, psychotherapy, physical and occupational therapy, durable medical equipment, and pharmacy fraud. This latest takedown is indicative of aggressive health care enforcement efforts by the federal government. While clinical laboratories were not implicated in this latest round of charges, there are many instances where labs have paid millions of dollars to settle alleged kickbacks and false claims. Takeaway: Clinical laboratories need to be aware of aggressive enforcement efforts being used by federal agencies and ensure they comply with all relevant laws and regulations.