Feds bust 91 people in $429M Medicare fraud takedown

The Centers for Medicare & Medicaid Services charged 91 people in seven cities for Medicare fraud totaling $429.2 million in alleged false billing. The massive bust signals more huge takedowns from authorities.

Within a 24-hour period, most of the charged individuals, which include doctors, nurses, healthcare company owners and other licensed medical professionals, were arrested or surrendered, the agency announced yesterday. The charges include conspiracy to commit healthcare fraud, healthcare fraud, anti-kickback violations and money laundering.

U.S. Department of Health & Human Services Secretary Kathleen Sebelius cited the reform law for providing new tools to fight fraud, as well giving new authority to suspend payments until fraud allegations have been resolved, according to the CMS statement.

In Miami, the feds charged 33 people for their alleged involvement in fraud schemes that led to $204.5 million in false billings for home healthcare, mental health services, and occupational and physical therapy. Seven hospital administrators in Houston face charges for giving Medicare patients cigarettes and hospital gift shop coupons in exchange for their participation in partial hospitalization program of mentally ill patients.

Yesterday's Medicare fraud bust follows another massive takedown in May, when officials arrested more than 100 people and charged them with defrauding the government of more than $450 million.

To further healthcare fraud prevention and monitoring, CMS in July opened up a $3.6 million facility in Baltimore that brings together clinicians, data analysts, fraud investigators and policy experts in one physical space to speed up anti-fraud efforts.

To learn more:
- read the CMS statement