DOJ Charges 243 Medical Personnel with $712 Million in Medicare Fraud

The federal government has charged 243 people in what may be the largest case medical billing fraud in U.S. history, officials announced on June 18.

The 243 doctors, nurses and other medical professionals charged had participated in “Medicare fraud schemes involving approximately $712 million in false billings,” according to Attorney General Loretta Lynch.

A nationwide investigation by the Departments of Justice and Health and Human Services’ Medicare Fraud Strike Force in 17 districts revealed the fraudulent billing, which is the largest the task force has seen in terms of number of people charged and the amount lost.

“This action represents the largest criminal health care fraud takedown in the history of the Department of Justice and it adds to an already remarkable record of enforcement,” Lynch told reporters in a statement.

Several healthcare providers were also suspended by the Centers for Medicare and Medicaid Services after the sweep. Although some healthcare providers outsource billing, which can speed up accounts receivable by one to three days, it was the doctors and other medical personnel who were held accountable.

Of the arrests made, 73 were from South Florida, including the Miami area. In total, the tried to take more than $262,567,878 from Medicare and Medicaid funds.

Lynch said that the defendants include “doctors, patient recruiters, home healthcare providers, pharmacy owners and others.”

Many of the healthcare providers took advantage of Medicare Part D. The program is supposed to allow the elderly and disabled to get prescription drugs through pharmacies who are later reimbursed by private insurers through Medicare.

But several pharmacies were caught submitting false prescriptions, which potentially costs the United States billions of dollars each year.

Since the strike force was initiated, the Departments of Justice and Health and Human Services have charged more than 2,300 defendants guilty of billing Medicare in excess of $7 billion.

The Justice Department has also relied on the federal False Claims Act in order to recoup more than $15.2 billion in Medicare losses since 2009.

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