Remarks by Acting Assistant Attorney General David A. O’Neil for the Medicare Fraud Strike Force Takedown
In today’s nationwide takedown, scores of defendants were arrested across the country for engaging in health care fraud – to the tune of hundreds of millions of dollars in fraudulent bills to Medicare. Among the defendants charged today were doctors, home health care providers, doctor’s assistants, pharmacy owners and medical supply company executives. The crimes charged represent the face of health care fraud today – doctors billing for services that were never rendered, supply companies providing motorized wheelchairs that were never needed, recruiters paying kickbacks to get Medicare billing numbers of patients. The fraud was rampant, it was brazen, and it permeated every part of the Medicare system.
But law enforcement is striking back. In Brooklyn, Tampa, Detroit, Houston, Los Angeles, and right here in Miami, 90 defendants were charged today with having submitted over $260 million in fraudulent claims to Medicare. Using cutting-edge, data-driven investigative techniques to find fraud, we are bringing fraudsters to justice and saving the American taxpayers billions of dollars. Overall, since its inception, the Department of Justice’s Medicare Strike Force has charged nearly 1,900 individuals involved in approximately $6 billion of fraud.
Today’s defendants played a variety of key roles in the schemes alleged in this takedown. But most strikingly, at the center of this takedown are the 27 medical professionals, including 15 physicians, who we allege breached the public trust and their professional duties of care, selling out their medical licenses for the lure of easy money.
For example, in Houston, we are announcing charges against five doctors employed by a health care clinic who were paid to provide $1.4 million worth of referrals for home health treatments that were not necessary and often not even provided.
In Los Angeles, we have charged a physician with false billings for medically unnecessary home health and medical equipment orders that cost Medicare over $23 million -- including hundreds of expensive power wheelchairs for people who did not need or want them.
In some of these schemes, we saw doctors going to extravagant lengths to conceal their fraud. In Detroit, we charged a doctor who allegedly conspired with his billing company to conceal his false billings through a complex web of sham partnerships with other health care companies.
In other schemes, we seized extravagant fruits of the crimes, including bank accounts, jewelry, and luxury vehicles tied to the scheme.
The foundation for the success of the Medicare Fraud Strike Force is data. Cold, hard data. Medicare recently made physician billing data public for the first time, which has prompted reporters and researchers to take a close look at who is billing Medicare for what. Our agents and prosecutors have used those numbers and other real-time data for years. We take that data, provided to us by CMS, and we use sophisticated analytic tools to identify billing patterns that stand out compared to other health care providers in their communities. The result? We have identified billions of dollars in Medicare fraud, spread across the country. This real-time data helps us pinpoint new schemes as they arise so we can stay one step ahead of the fraudsters.
But it is not just data. We are also using traditional law enforcement techniques used in other types of investigations, like those used in corruption or organized crime cases, to develop evidence. Undercover officers, Title III wiretaps, hidden cameras, GPS trackers. And I also want to highlight the role that Medicare beneficiaries can play in rooting out fraud. In many of the schemes charged today, powerful evidence of fraud came from Medicare beneficiaries finding out what was billed to Medicare using their numbers and coming forward to tell law enforcement what they were seeing.
We are investigating and prosecuting all levels of these schemes - from the recruiters to the medical professionals to the owners of these clinics. We will bring to justice those who steal from Medicare. With an overall conviction rate of 95%, the Medicare Fraud Strike Force has sent that message to over 1,400 Medicare fraudsters who have been convicted since the Strike Force began operations in 2007. In fact, just yesterday, a jury convicted a Dallas doctor who took cash in exchange for falsely certifying that Medicare beneficiaries qualified for home health services.
Make no mistake, together with our partners in the U.S. Attorneys’ Offices, the FBI, and the Department of Health and Human Services, the Criminal Division of the Department of Justice will continue to aggressively investigate health care fraud using every tool available to us. We are committed to the fight against Medicare fraud. We will bring to justice those who loot our nation’s health care funds, and we will recover what has been stolen.
Updated September 17, 2014