HEAT “Takes Down” Medicare Fraud Ring

Federal agents arrested 53 people in Detroit, Miami, Denver, and New York City, June 24, for allegedly scheming to defraud the government of more than $50 million in false Medicare claims. Physicians, medical assistants, health care executives, and beneficiaries were among the accused for various Medicare fraud offenses, including conspiracy to defraud the Medicare program, criminal false claims, and violations of the anti-kickback statutes.

Strike Force operations in Detroit identified two primary areas—infusion therapy and physical/occupational therapy providers—in which schemes were allegedly orchestrated to defraud the Medicare program, according to a Department of Health and Human Services (HHS) press release.

According to the indictments, the defendants participated in schemes to submit claims to Medicare for treatments that were medically unnecessary and oftentimes never provided. Some indictments allege that beneficiaries accepted cash kickbacks in return for allowing providers to submit forms saying they had received the unnecessary and not provided treatments.

HHS Secretary Kathleen Sebelius said, “Thanks to cooperation from across the government and some of the best law enforcement professionals in the country, today we were able to save millions of dollars from being lost to criminals and send a powerful message to those who seek to defraud the system, that we are coming after them.”

The cases are being prosecuted by attorneys from the Department of Justice’s (DOJ) Criminal Division’s Fraud Section, including Deputy Chief Kirk Ogrosky and Trial Attorneys John K. Neal and Benjamin D. Singer, as well as Special Assistant U.S. Attorney Thomas W. Beimers in the U.S. Attorney’s Office for the Eastern District of Michigan, on detail from the Office of Inspector General (OIG).

The Strike Force operations in Detroit are part of the Health Care Fraud Prevention & Enforcement Action Team (HEAT), a renewed effort announced in May 2009 between the DOJ and HHS.

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