National healthcare fraud takedown results in charges against 590+ individuals, including one in Georgia, who are responsible for $2+ billion in fraud losses
ATLANTA – The Department of Justice (DOJ) and the Department of Health and Human Services (HHS) announced the largest ever health care fraud enforcement action by the Medicare Fraud Strike Force, involving 590+ charged defendants across 56 federal districts, including 150+ doctors, nurses, and other licensed medical professionals, for their alleged participation in health care fraud schemes involving approximately $2 billion in false billings. Of those charged, over 150 defendants, including doctors, were charged for their roles in prescribing and distributing opioids and other dangerous narcotics. Twenty-nine state Medicaid Fraud Control Units also participated in today’s arrests. In addition, HHS has initiated suspension actions against 587 providers, including doctors, nurses and pharmacists.
The charges announced today aggressively target schemes billing Medicare, Medicaid, and TRICARE (a health insurance program for members and veterans of the armed forces and their families) for medically unnecessary prescription drugs and compounded medications that often were never even purchased and/or distributed to beneficiaries. The charges also involve individuals contributing to the opioid epidemic, with a particular focus on medical professionals involved in the unlawful distribution of opioids and other prescription narcotics, a particular focus for the Department. According to the CDC, approximately 115 Americans die every day of an opioid related overdose.
“Health care fraud steals valuable resources from individuals who are most in need of the funds that support medical services and programs,” said U. S. Attorney Byung J. Pak. “We will continue to focus our efforts on aggressively investigating and prosecuting medical professionals and others who defraud our healthcare system”
“Health care fraud is a betrayal of vulnerable patients, and often it is theft from the taxpayer,” said Attorney General Sessions. “In many cases, doctors, nurses, and pharmacists take advantage of people suffering from drug addiction in order to line their pockets. These are despicable crimes.”
“Health care fraud costs taxpayers billions of dollars and places our most vulnerable citizens at risk for harm and neglect,” said Derrick L. Jackson, Special Agent in Charge for the U.S. Department of Health & Human Services - Office of Inspector General. “Working with our law enforcement partners, we are dedicated to protecting patients and the federal health care programs intended to serve them.”
“The FBI is dedicated to protecting federally funded health care programs from those driven by greed, those who divert funds to their own pockets, taking them away from those who desperately need them,” said J. C. Hacker, Acting Special Agent in Charge (A/SAC) of FBI Atlanta. “The scope of this case is an indication of how widespread the problem is, but also an indication of how determined we are to stop it.”
“Our Medicaid Fraud Control Unit is committed to protecting the integrity of the Georgia Medicaid program, its members and the taxpayer dollars used to provide this service,” said Georgia Attorney General Chris Carr. “We will remain vigilant in our efforts to identify and detect fraud, abuse or waste and aggressively recover all funds spent inappropriately. We are grateful to work with our partners at the U.S. Attorney’s Office and law enforcement to protect Georgians.”
According to court documents, the defendants allegedly participated in schemes to submit claims to Medicare, Medicaid, TRICARE, and private insurance companies for treatments that were medically unnecessary and often never provided. In many cases, patient recruiters, beneficiaries and other co-conspirators were allegedly paid cash kickbacks in return for supplying beneficiary information to providers, so that the providers could then submit fraudulent bills to Medicare for services that were medically unnecessary or never performed. Collectively, the doctors, nurses, licensed medical professionals, health care company owners and others charged are accused of submitting a total of over $2 billion in fraudulent billings. The number of medical professionals charged is particularly significant, because virtually every health care fraud scheme requires a corrupt medical professional to be involved in order for Medicare or Medicaid to pay the fraudulent claims. Aggressively pursuing corrupt medical professionals not only has a deterrent effect on other medical professionals, but also ensures that their licenses can no longer be used to bilk the system.
Specifically, the Northern District of Georgia case announced as part of the nationwide Medicare Strike Force takedown:
United States v Rosa Fitzhugh
According to U.S. Attorney Pak, the indictment, and other information presented in court: Rosa Fitzhugh owned and operated Casa Luisa, Inc. with locations in Decatur, Georgia. Fitzhugh was a licensed professional counselor (“LPC”) that purportedly provided mental health counseling. In 2014, Fitzhugh and Casa Luisa, Inc. were terminated from several Medicaid funded care management organizations (“CMOs”). After termination, Fitzhugh continued to fraudulently bill these CMOs by contracting with enrolled LPCs. Fitzhugh solicited LPCs to work as independent contractors with companies she controlled and then fraudulently billed CMOs using the LPCs provider numbers for services that were not provided.
Beginning in January 2015, and continuing until October 2017, Fitzhugh billed or directed others to fraudulently bill over $2.4 million to Medicaid CMOs by billing for individual and family psychotherapy services that were not provided, not provided as billed, and not entitled to reimbursement.
The case is being investigated by the U.S. Department of Health & Human Services, Office of the Inspector General, the Federal Bureau of Investigation, and the Georgia State Attorney General’s Medicaid Fraud Control Unit.
Jeffrey Brown, Deputy Chief of the Complex Frauds Section and Assistant Attorney General Elizabeth Grofic are prosecuting the case.
Members of the public are reminded that the indictment only contains charges. The defendants are presumed innocent of the charges and it will be the government’s burden to prove the defendants’ guilt beyond a reasonable doubt at trial.
For further information please contact the U.S. Attorney’s Public Affairs Office at USAGAN.PressEmails@usdoj.gov or (404) 581-6016. The Internet address for the U.S. Attorney’s Office for the Northern District of Georgia is http://www.justice.gov/usao-ndga.