Healthcare FraudThe U.S. Departments of Justice and Health and Human Services have charged 301 defendants for $900M in fraudulent Medicaid and Medicare billings. Defendants include sixty-one licensed medical professionals in the nation’s largest healthcare fraud sweep to date. The charges include numerous healthcare fraud related crimes, including conspiracy to commit healthcare fraud, violations of the anti-kickback statutes, money laundering and aggravated identity theft. The alleged fraudulent schemes involve various medical treatments and services, including home health services, psychotherapy, physical and occupational therapy, durable medical equipment and prescription drugs. Justice.gov states:

According to court documents, patient recruiters, Medicare 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. Collectively, the doctors, nurses, licensed medical professionals, healthcare company owners and others charged are accused of submitting a total of approximately $900M in fraudulent billing. Some the Strike Force locations include:

  • The Southern District of Florida, a total of 100 defendants were charged with offenses relating to their participation in various fraud schemes involving approximately $220 million in false billings for home health services, mental health services and pharmacy fraud.
  • In the Southern District of Texas, 24 individuals were charged in cases involving over $146 million in alleged fraud.  One of these defendants is a physician with the highest number of referrals for home health services in the Southern District of Texas.
  • In the Southern District of Texas, 24 individuals were charged in cases involving over $146 million in alleged fraud.  One of these defendants is a physician with the highest number of referrals for home health services in the Southern District of Texas.

Heathcare fraud on the national level is a serious crime involving millions of dollars.  In this Medicare Fraud Strike Force sweep, the investigation found doctors and nurses who submitted claims to Medicare and Medicaid for medically unnecessary treatments or services that were never provided. In this type of litigation, healthcare fraud expert witnesses are called upon to consult and testify on complex issues regarding HMO contracting, Medicare, and Medicaid. These experts are informed on healthcare regulations and statutes. Healthcare fraud experts can also provide insightful testimony on insurance plans vulnerable to deceptive practices as well as evaluating whether healthcare professionals have committed healthcare fraud.

By Karen Olson, 20+ years of legal industry research.