This June, federal officials announced the largest coordinated criminal Medicare fraud action and the first large-scale effort focused on Medicare Part D fraud in the history of the U.S. Justice Department. The Medicare Fraud Strike Force levelled charges against 243 individuals across the country accused of falsely billing $712 million to Medicare in a number of separate schemes. Those charged with fraud under the False Claims Act included 46 doctors, nurses and other licensed medical professionals.
More than 44 of those arrested were charged with Medicare fraud related to Medicare Part D, which is Medicare’s drug benefit program.
HHS Inspector General Daniel Levinson emphasized that costs in Medicare Part D reached $121 billion last year.
Prosecuting this type of qui tam fraud in Part D can sometimes be more difficult than in other areas of Medicare because Part D payments are capitated, rather than fee-for-service.
The 243 individuals accused of violations of the False Claims Act in this federal effort to crack down on fraud were charged with a variety of crimes, including conspiracy to commit healthcare fraud, violating the anti-kickback statute, money laundering and aggravated identity theft. The fraudulent schemes occurred in home healthcare, psychotherapy, physical and occupational therapy, durable medical equipment and pharmacy fraud.
The cases are being prosecuted and investigated by Medicare Fraud Strike Force teams from the Fraud Section of the Justice Department’s Criminal Division and from U.S. attorney’s offices around the country.