Monday, July 11, 2016

DOJ Arrests in $900M Medicare Fraud Takedown

Dianne De La Mare

The U.S. Department of Justice (DOJ) and the U.S. Department of Health, Office of Inspector General (OIG) have recently announced the largest health care fraud takedown in history. Approximately 300 defendants in 36 judicial districts were charged with participating in fraud schemes involving approximately $900 million in false billings to the Medicare and Medicaid programs. According to the DOJ press release, the accused parties were charged with various health care fraud-related crimes, including conspiracy to commit health care fraud, anti-kickback statute violations, money laundering and aggravated identity theft.

The charges are based on a variety of alleged fraud schemes involving various medical treatments and services, including home health care, psychotherapy, physical and occupational therapy, durable medical equipment (DME), and prescription drugs. More than 60 individuals were arrested on fraud charges related to the Medicare prescription drug benefit program (e.g., Medicare, Part D). The OIG has released a fact sheet about the takedown, describing the scope, schemes, use of data analytics and administrative enforcement actions.

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