fraud

100 South Floridians Indicted In Biggest Healthcare Fraud Takedown In U.S.

The U.S. departments of Justice and Health and Human Services on Wednesday morning jointly announced the largest healthcare fraud takedown in U.S. history.

The Southern District of Florida is home to about one-third of the defendants charged and about one-fourth of the allegedly fraudulent billings.

Combined, the 301 individuals charged nationwide were involved in alleged schemes which resulted in $900 million in false billings.

“As this takedown should make clear, health care fraud is not an abstract violation or benign offense. It is a serious crime,” Attorney General Loretta Lynch said. “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.”

The hundreds of defendants, charged over the past three days, allegedly took part in schemes to submit Medicare and Medicaid claims for treatments that were medically unnecessary or never provided

The announcement follows a similar historic sting last June, when regulators charged 73 South Floridians as part of what was then the largest health care fraud bust in the nation’s history. Those cases involved 243 defendants and netted an alleged $712 million in fraudulent billings.

“We saw new trends emerging in this year’s charges,” Lynch said. “In a number of cases involving Medicare prescription drugs, known as Part D, we saw new evidence of identity theft, including the use of doctors’ stolen IDs.”

The ways to commit fraud tend to gain popularity and then fall out of trend as regulators and law enforcement crack down on specific types of fraud.

In addition to Part D fraud, which was a big part of last year’s takedown, Lynch noted that compounding fraud was on the rise this year. Compounding drugs, prescription drugs that have been combined, are an attractive area for fraud because compounded medication tends to be expensive.

“The U.S. Attorney’s Office for the Southern District of Florida remains relentless in combating health care fraud,” U.S. Attorney Wifredo A. Ferrer said. “The takedown announced today … demonstrates that we continue to prosecute every link in the health care fraud chain – from the pharmacy or home health agency owner that submits false claims to the Medicare beneficiaries who decide to abuse their health care privileges.”

The 100 defendants charged in the Southern District of Florida accounted for about $220 million in false billing, according to the U.S. Attorney’s Office. The cases involved Medicare Part D, home health care services, community mental health, Medicare advantage, private insurance and Tricare.

One case resulted in an alleged $21.3 million being paid out for false and fraudulent claims, according to the U.S. Attorney’s Office.

Source:  SFBJ

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