In today’s charges, the Medicare Strike Force and 30 state Medicaid Control Units aided in the arrests of the 412 defendants, 115 of which are licensed medical professionals. In addition, the HHS initiated suspensions for 295 healthcare providers (including nurses, physicians and pharmacists).
Full Answer
Where is the DOJ’s Medicare fraud strike force?
· Largest Health Care Fraud Enforcement Action in Department of Justice History. Attorney General Jeff Sessions and Department of Health and Human Services (HHS) Secretary Tom Price, M.D., announced today the largest ever health care fraud enforcement action by the Medicare Fraud Strike Force, involving 412 charged defendants across 41 federal districts, …
How many people have been charged with Medicare fraud?
· By Thomas Beaton July 21, 2017 - The Department of Justice (DoJ) announced the largest ever healthcare enforcement action in the history of the federal agency took place when the Medicare Fraud...
How much did the DOJ charge for telemedicine fraud?
· Last Thursday, the US Department of Justice (DOJ) announced it had charged 412 people across the country with crimes related to health care fraud and opioid abuse, which, the agency claimed, cost ...
How many physicians were charged in the Ohio Medicaid fraud case?
· The Department of Justice announced criminal charges against 42 medical professionals and nearly 100 other people for alleged health-care fraud that involved about $1.4 billion in suspected losses ...
What is the sentence for Medicare fraud?
According to the CMS, these individuals may be imprisoned for up to 10 years. If an alleged scheme causes another person's injury or death, the maximum possible periods of incarceration rise. Furthermore, individuals who have been convicted of Medicare fraud may be ordered to pay fines worth up to $250,000.
Who is responsible for the bulk of fraud in Medicare and Medicaid?
Medicare and Medicaid fraud can be committed by medical professionals, healthcare facilities, patients, and others who pretend to be one of these parties. Common examples of fraud include billing for services that weren't provided, performing unnecessary tests, and receiving benefits when you're not eligible.
Who enforces Medicare fraud?
Government agencies, including the U.S. Department of Justice (DOJ), the U.S. Department of Health & Human Services (HHS), the HHS Office of Inspector General (OIG), and the Centers for Medicare and Medicaid Services (CMS), enforce these laws.
What is the US Department of Justice Medicare fraud strike force?
Specifically, the National Rapid Response Strike Force was created in 2020 with a mission to investigate and prosecute fraud cases involving major health care providers that operate in multiple jurisdictions, including major regional health care providers operating in the Strike Force cities, with a focus on ...
What is the penalty for violating the False Claims Act?
The False Claims Act, 31 U.S.C. §§ 3729, provides that anyone who violates the law “is liable to the United States Government for a civil penalty of not less than $5,000 and not more than $10,000, . . . plus 3 times the amount of damages.” But how does that apply in practice?
Who enforces Stark Law?
Government agencies, including the U.S. Department of Justice (DOJ), the U.S. Department of Health & Human Services (HHS), the HHS Office of Inspector General (OIG), and the Centers for Medicare & Medicaid Services (CMS), enforce these laws. The civil FCA, 31 United States Code (U.S.C.)
Which of the following penalties could the courts impose on violators of the Stark Statute Select all that apply?
Penalties for violating Stark can be severe. They include denial of payment, refund of payment, imposition of a $15,000 per service civil monetary penalty and imposition of a $100,000 civil monetary penalty for each arrangement considered to be a circumvention scheme.
Who enforces the Anti-Kickback Statute?
The Department of Justice (DOJ) enforces the criminal penalties of the AKS. The criminal penalties include fines of up to $100,000 and ten-years' imprisonment. Violations of the AKS may also result in civil penalties.
What are some of the penalties for violating fraud waste and abuse laws?
Penalties include fines up to $25,000, imprisonment for up to 5 years and exclusion from Federal Health Care Programs (e.g., Medicaid & Medicare). *Remuneration is defined as the transfer of anything of value, directly or indirectly, overtly or covertly in cash or in kind, including kickbacks, bribes or rebates.
What organizations are part of the Healthcare Fraud Prevention and Enforcement Action Team?
In this past fiscal year, the HCFAC program has returned $5.0 for each dollar invested. The Health Care Fraud Prevention and Enforcement Action Team (HEAT), a joint initiative between HHS, OIG, and DOJ, has played a critical role in the fight against health care fraud.
What is the overall Medicare claims improper payment amount each year?
In total, Medicare improper payments were estimated to be $43 billion in fiscal year 2020. However, the amount of improper payments made in Medicare are significant, accounting for over one-quarter of the total amount of improper payments made government-wide in fiscal year 2019.
What type of clients does the federal Stark Law prohibit a physician from referring to a health care provider if a financial relationship exists?
The Physician Self-Referral Law, commonly referred to as the Stark law, prohibits physicians from referring patients to receive "designated health services" payable by Medicare or Medicaid from entities with which the physician or an immediate family member has a financial relationship, unless an exception applies.
What is the most common Medicare fraud?
The following are the most common areas of healthcare fraud of which you should be aware:#5 – Kickback Schemes. ... #4 – Medically Unnecessary Services. ... #3 – Failure to Properly Charge Medicare and Medicaid Patients for Prescriptions. ... #2 – Allowing Nurses and Staff to Perform Examinations. ... #1 – Upcoding.More items...•
Which of the following is an example of Medicaid fraud?
Intentionally billing for unnecessary medical services or items. Intentionally billing for services or items not provided.
How can Medicare fraud be prevented?
There are several things you can do to help prevent Medicare fraud.Protect your Medicare number. Treat your Medicare card and number the same way you would a credit card number. ... Protect your medical information. ... Learn more about Medicare's coverage rules. ... Do not accept services you do not need. ... Be skeptical.
What are the telemedicine cases?
The telemedicine cases built on prosecutions launched in 2019 and 2020, which involved allegations of billing Medicare for fraudulent genetic cancer testing, and telemedicine executives paying doctors and others to order unnecessary durable medical equipment, diagnostic testing and medications, either without actually interacting with patients or having a brief call with ones they had never met or seen.
How many people died from opioid overdoses in 2020?
Polite noted that opioid-related overdoses killed a “record number of Americans, nearly 70,000,” last year, and that drug overdose deaths overall increased by more than 30%, with 90,000 people dead as a result in 2020.
How many people were charged with fraud?
Federal prosecutors charged 14 people — including a medical doctor and owners of laboratories, pharmacies and a home health agency — in multiple fraud schemes that allegedly bilked consumers and insurers out of $143 million, the Department of Justice announced Wednesday.
How much money was stolen from a sham pharmacy?
In New York, charges were brought against two people who owned several pharmacies and sham pharmacy wholesaling companies for allegedly committing health-care fraud, wire fraud and money laundering totaling $45 million. The two and their co-conspirators allegedly acquired billing privileges for multiple pharmacies.
What were the charges against the two people who owned pharmacies and sham pharmacies?
In New York, charges were brought against two people who owned several pharmacies and sham pharmacy wholesaling companies for allegedly committing health-care fraud, wire fraud and money laundering totaling $45 million. The two and their co-conspirators allegedly acquired billing privileges for multiple pharmacies. They also allegedly submitted fraudulent claims to Medicare by abusing emergency Covid-19 rules to avoid otherwise applicable limits on refills for expensive drugs. The DOJ news release said the defendants “allegedly used an elaborate network of international money laundering operations to conceal and disguise the proceeds of the scheme.”
What is the DOJ prosecuting?
Here are some of the cases the DOJ announced it is prosecuting: In Arkansas, a man who owns two testing laboratories was charged with health-care fraud in connection with an alleged scheme to defraud the U.S. of more than $88 million.
What is the Medicare fraud strike force?
Since its inception in March 2007, the Medicare Fraud Strike Force, which maintains 15 strike forces operating in 24 federal districts, has charged more than 4,200 defendants who have collectively billed the Medicare program for nearly $19 billion. In addition, the HHS Centers for Medicare and Medicaid Services, working in conjunction with the HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.
Who are the defendants in the sham pharmacy fraud case?
Peter Khaim, 41, and Arkadiy Khaimov, 38 , both of Forest Hills, New York, who owned and controlled several New York pharmacies and sham pharmacy wholesaling companies, were charged in a superseding indictment for their participation in an alleged $45 million health care fraud, wire fraud, and money laundering scheme. The defendants and their co-conspirators allegedly obtained billing privileges for multiple pharmacies by using nominees to serve as the purported owners and supervising pharmacists. The defendants then allegedly submitted false and fraudulent claims to Medicare, including by using COVID-19 “emergency override” billing codes to circumvent otherwise applicable pre-authorization requirements and limits on the frequency of refills for expensive drugs (primarily, the cancer treatment gels Targretin and Panretin). The defendants allegedly used an elaborate network of international money laundering operations to conceal and disguise the proceeds of the scheme. The case is being prosecuted by Trial Attorney Andrew Estes of the Brooklyn Strike Force.
How to report fraud to the Department of Justice?
To report suspected fraud, contact the National Center for Disaster Fraud (NCDF) at (866) 720-5721 or file an online complaint at: https://www.justice.gov/disaster-fraud/webform/ncdf-disaster-complaint-form. Complaints filed will be reviewed at the NCDF and referred to federal, state, local, or international law enforcement or regulatory agencies for investigation.
Who are the two people charged with kickbacks?
Juan Nava Ruiz , 44, and Eric Frank, 47, both of Coral Springs, Florida, were charged for an alleged $9.3 million health care kickback scheme, along with Christopher Licata, 44, of Boca Raton, Florida, who was previously charged in a separate Indictment. Licata, an owner of Boca Toxicology, LLC, a clinical laboratory based in Boca Raton, allegedly offered and paid kickbacks to patient brokers, including Ruiz and Frank, in exchange for referring Medicare beneficiaries to Boca Toxicology for various forms of genetic testing and other laboratory testing that they did not need, including the submission of $422,748 in claims related to medically unnecessary respiratory pathogen panel testing and genetic testing that was improperly bundled with COVID-19 testing. The cases are being prosecuted by Trial Attorney Jamie de Boer of the Miami Strike Force.
Who is Billy Joe Taylor?
Taylor, the owner and operator of Vitas Laboratories LLC and Beach Tox LLC, two testing laboratories, allegedly used access to beneficiary and medical provider information from prior laboratory testing orders to submit fraudulent claims for urine drug tests and other laboratory tests, including respiratory pathogen panel and COVID-19 tests, that were not actually ordered or performed. The complaint also alleges that hundreds of claims were submitted for beneficiaries after they had died or otherwise ceased providing samples. The case is being prosecuted by Senior Litigation Counsel James Hayes and Trial Attorney D. Keith Clouser of the National Rapid Response Strike Force, and Assistant U.S. Attorney Kenneth Elser of the U.S. Attorney’s Office for the Western District of Arkansas.
Who is the trial attorney for Malena Lepetich?
The cases are being prosecuted by Trial Attorney Jamie de Boer of the Miami Strike Force. Middle District of Louisiana. Malena Lepetich, 38, of Belle Chase, Louisiana, was charged for an alleged $15 million scheme to commit health care fraud, to defraud the United States, and to pay and receive health care kickbacks.
Is an indictment an allegation?
An indictment, complaint, or information is merely an allegation, and all defendants are presumed innocent until proven guilty beyond a reasonable doubt in a court of law.
How many defendants were charged with Medicare fraud?
Prior to the charges announced as part of today’s nationwide enforcement action and since its inception in March 2007, the Health Care Fraud Strike Force program had charged more than 4,200 defendants who have collectively billed the Medicare program for approximately $19 billion.
How much fraud was alleged in the case of Telemedicine?
The largest amount of alleged fraud loss charged in connection with the cases announced today – $4.5 billion in allegedly false and fraudulent claims submitted by more than 86 criminal defendants in 19 judicial districts – relates to schemes involving telemedicine: the use of telecommunications technology to provide health care services remotely. According to court documents, certain defendant telemedicine executives allegedly paid doctors and nurse practitioners to order unnecessary durable medical equipment, genetic and other diagnostic testing, and pain medications, either without any patient interaction or with only a brief telephonic conversation with patients they had never met or seen. Durable medical equipment companies, genetic testing laboratories, and pharmacies then purchased those orders in exchange for illegal kickbacks and bribes and submitted false and fraudulent claims to Medicare and other government insurers. In addition to the criminal charges announced today, CMS Center for Program Integrity separately announced that it has taken a record-breaking number of administrative actions related to telemedicine fraud, revoking the Medicare billing privileges of 256 additional medical professionals for their involvement in telemedicine schemes.
How much money was lost in the opioid takedown?
National Health Care Fraud and Opioid Takedown Results in Charges Against 345 Defendants Responsible for More than $6 Billion in Alleged Fraud Losses | OPA | Department of Justice
What is the National Rapid Response Strike Force?
The National Rapid Response Strike Force’s mission is to investigate and prosecute fraud cases involving major health care providers that operate in multiple jurisdictions, including major regional health care providers operating in the Criminal-Division-led Health Care Fraud Strike Forces throughout the United States. The National Rapid Response Strike Force led the telemedicine initiative and helped lead the sober homes cases included in today’s announcement.
Who is the acting assistant attorney general of the FBI?
Acting Assistant Attorney General Brian C. Rabbitt of the Justice Department’s Criminal Division, Assistant Director Calvin Shivers of the FBI’s Criminal Investigative Division, Deputy Inspector General Gary Cantrell of the Department of Health and Human Services Office of Inspector General (HHS-OIG) and Assistant Administrator Tim McDermott of the Drug Enforcement Administration (DEA) today announced a historic nationwide enforcement action involving 345 charged defendants across 51 federal districts, including more than 100 doctors, nurses and other licensed medical professionals.
Is an indictment an allegation?
A complaint, information or indictment is merely an allegation, and all defendants are presumed innocent until proven guilty beyond a reasonable doubt in a court of law.