U.S. charges 89 people in $223 million Medicare fraud schemes

WASHINGTON Tue May 14, 2013 4:05pm EDT

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WASHINGTON (Reuters) - Federal officials charged 89 people including doctors, nurses and other medical professionals in eight U.S. cities on Tuesday with Medicare fraud schemes that the government said totaled $223 million in false billings.

In the latest big Medicare fraud crackdown, more than 400 law enforcement officers including FBI agents fanned out in Miami, Detroit, Los Angeles, New York and other cities to make arrests. Authorities said suspects posed as physicians, preyed on the poor and otherwise scammed the $590 billion healthcare program with phony or unnecessary bills.

About one in four defendants was a doctor, a nurse, a physical therapist or some other medical professional.

"In many of these alleged schemes, the fraudulent billings could not have occurred without a doctor signing off on bogus services, or a nurse or therapist filling out false paperwork," Acting U.S. Assistant Attorney General Mythili Raman told reporters.

"In all of the ... schemes, profit was the driving force," she said.

Officials said the action was the sixth "national takedown" by the government's Medicare Fraud Strike Force, which has arrested more than 1,500 people on charges related to $5 billion in allegedly false Medicare claims since 2007.

The Obama administration has put a priority on combating fraud, waste and abuse in the Medicare program for the elderly and disabled as a way to restrain government healthcare spending and its impact on the federal budget deficit.

U.S. officials say the battle against fraud returns about $8 to the Treasury and the Medicare trust fund for every $1 invested. They also claim that regular crackdowns have acted as a deterrent against wrongdoing.

Attorney General Eric Holder warned that the anti-fraud effort could be hampered by automatic across-the-board budget cuts known as sequestration, which he said has reduced the Justice Department's budget by $1.6 billion this year.

"Unless Congress adopts a balanced deficit reduction plan and stops the reductions currently slated for 2014, I fear our capacity to protect the American people from healthcare fraud, to safeguard vital programs and precious resources and to hold criminals accountable will be further reduced," Holder said.

"Allowing these cuts would be both unwise and unacceptable," he added.

Sequestration came into effect in March after Congress failed to overcome political barriers to a wide-ranging deal on deficit reduction. The automatic cuts are expected to trim $1.2 trillion from the federal deficit over 10 years.

Health and Human Services Secretary Kathleen Sebelius said the anti-fraud effort has become more effective in recent years because federal authorities can now suspend Medicare payments and reimbursements to healthcare providers facing credible allegations. "It's that broader authority that helps us ... get results faster," she said.

The latest alleged schemes ran the gamut of Medicare fraud.

Many involved bribing beneficiaries for Medicare information used to bill for home health and other services that were never performed or were medically unnecessary.

Suspects in Houston and Los Angeles were accused of using recruiters to collect Medicare information. Others in Tampa, Florida, were charged with healthcare-related money laundering and with setting up healthcare clinics that charged for surgery that was never performed.

In Miami, 25 defendants were charged in schemes totaling $44 million. One of the leading suspects there allegedly spent much of the money on luxury automobiles including two Lamborghinis, a Ferrari and a Bentley.

Officials did not speculate on how many of those charged might face jail time if convicted.

"There are Medicare fraudsters in prisons across the country, some who will be there for decades, who can attest to our determination and effectiveness," Raman said.

(Reporting by David Morgan; Editing by David Gregorio)

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