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Nationwide Health Care Fraud Sweep

Posted by Courtney Pilchman | Jun 26, 2016 | 0 Comments

United States Attorney General Loretta E. Lynch announced the nationwide sweep of a Medicare Fraud Strike Force that included individuals from 36 federal districts. In total, 301 people were criminally charged with participating in health care fraud schemes involving $900 million in false billings, including 61 physicians, nurses and various licensed medical professionals. In addition to Medicare, twenty-three states Medicaid Fraud Control Units also participated in the raid and HHS Centers for Medicare & Medicaid Services (CMS) is suspending payments to providers who were named in various indictments and criminal complaints. The sweep was the largest in history in terms of amount of loss and criminal defendants.

All of the defendants were charged with various health care fraud charges, including money laundering, anti-kickback statutes and conspiracy to commit health care fraud. The charges stem from various medical treatment and services from home health care, psychotherapy, occupational therapy, DME and prescription drugs.

The U.S. Attorney's office also announced the $350 million allocated from the Affordable Care Act toward the investigation and prosecution of health care related fraud. The Medicare Fraud Strike Force operations are part of the Health Care Fraud Prevention & Enforcement Action Team (HEAT). They in 9 locations and have charged over 2,900 defendants who have falsely billed the Medicare program for over $8.9 billion. Including the most recent arrests, 1,200 people have been charged in national takedown operations, involving more than $3.4 billion in fraudulent billings.

  • Southern District of Florida, 100 defendants were charged with crimes involving approximately $220 million in false billings for home health care, mental health services and pharmacy fraud.
  • Southern District of Texas, 24 individuals were charged with crimes medical insurance fraud involving over $146 million.
  • Northern District of Texas, 11 people were charged in crimes involving health care theft over $47 million in alleged fraud.
  • Central District of California, 22 defendants were charged with crimes involving medical fraud of $162 million.
  • Eastern District of Michigan, 19 defendants were charged with kick backs and drug distribution schemes involving $114 million in false claims for services.
  • Tampa, Orlando and elsewhere in the Middle District of Florida, 15 individuals were charged with participating in compounding pharmacy fraud and intravenous prescription drug fraud involving $17 million in fraudulent billing.
  • Northern District of Illinois, 6 individuals were charged in false and fraudulent claims for home health services and disability benefits.
  • Eastern District of New York, 10 individuals were for their roles involving over $86 million in physical and occupational therapy claims to Medicare and Medicaid.

In addition to the Strike Force, today's enforcement actions include cases brought by 26 U.S. Attorney's Offices,

  • Northern District of Georgia, 9 defendants were charged for health care fraud schemes involving $7 million in fraudulent billings.
  • Western and Eastern Districts of Pennsylvania, 3 defendants were charged for embezzlement schemes.
  • Southern District of New York, a pharmacist was charged involving over $51 million in fraudulent Medicare and Medicaid billings.
  • Southern District of California, 8 individuals were charged in health care-related cases involving $27 million of fraudulent claims to insurance.

An indictment and complaint are simply allegations that must be proven by the government. All individuals who were arrested or charged are innocent until either a plea of guilty or a finding of guilty at the conclusion of a trial. It is incredibly important that those who have been charged in this massive health care fraud prosecution must seek qualified and competent attorneys and investigators to defend against these allegations.

Our California health care fraud lawyers have experience in both state and federal court prosecutions. We have the best and brightest investigators who comb through each and every piece of discovery in search of misinformation or inaccurate information that is often contained in large California health care insurance fraud cases.

Do not accept that if you are arrested or charged for health care fraud in California that you will be found guilty. Our firm has exonerated many clients who were charged with medical insurance fraud. Call our office today for a free consultation. We have office in Los Angeles, Orange County and the Inland Empire.

About the Author

Courtney Pilchman

Courtney Pilchman was a Deputy District Attorney for over six years prior to becoming a criminal defense attorney. She was a member of some of the most elite prosecution units including crimes against children, family violence, and sexual assault. She prosecuted very high profile cases and had a ...


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