From the US Dept of Justice on Health Care Fraud

Overview

Health care fraud costs the United States tens of billions of dollars each year. Some estimates put the figure close to $100 billion a year.  It is a rising threat, with national health care expenditures estimated to exceed $3 trillion in 2014. Health care fraud schemes continue to grow in complexity and seriousness.  The dedicated efforts of law enforcement are a major component of the fight against health care fraud.

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) established a national Health Care Fraud and Abuse Control Program (HCFAC or the Program) under the joint direction of the Attorney General and the Secretary of the Department of Health and Human Services (HHS), designed to coordinate Federal, state and local law enforcement activities with respect to health care fraud and abuse.  In its seventeenth year of operation, the Program’s continued success confirms the soundness of a collaborative approach to identify and prosecute the most egregious instances of health care fraud, to prevent future fraud and abuse, and to protect program beneficiaries.

On May 20, 2009, Attorney General Eric Holder and HHS Secretary Kathleen Sebelius announced the Health Care Fraud Prevention & Enforcement Action Team (HEAT), an initiative that combined increased tools and resources, with sustained focus by senior level leadership designed to enhance collaboration between the Department of Justice (DOJ) and investigative agencies.  With the creation of the new HEAT effort, DOJ pledged a cabinet-level commitment to prevent and prosecute health care fraud.  HEAT is comprisedof top level law enforcement agents, prosecutors, attorneys, auditors, evaluators, and other staff from DOJ, HHS, and their operating divisions, and is dedicated to joint efforts across government to both prevent fraud and enforce current anti-fraud laws around the country.

The mission of HEAT is:

  • To marshal significant resources across government to prevent waste, fraud and abuse in the Medicare and Medicaid programs and crack down on the fraud perpetrators who are abusing the system and costing us all billions of dollars.
  • To reduce skyrocketing health care costs and improve the quality of care by ridding the system of perpetrators who are preying on Medicare and Medicaid beneficiaries.
  • To highlight best practices by providers and public sector employees who are dedicated to ending waste, fraud, and abuse in Medicare.
  • To build upon existing partnerships between DOJ and HHS, such as our Medicare Fraud Strike Force Teams, to reduce fraud and recover taxpayer dollars.

The Criminal Division plays a critical role in HEAT. The Criminal Division’s Fraud Section has 40 prosecutors assigned on health care fraud matters across the country.  Most of these 40 prosecutors are assigned to the Medicare Fraud Strike Force (MFSF). Partnering with nine U.S. Attorney’s Offices, the MFSF has filed almost 1000 cases, charging over 2100 defendants who collectively billed the Medicare program more than $6.5 billion. Almost 1500 of these defendants pleaded guilty and 200 others were convicted in jury trials; over 1200 defendants were sentenced to imprisonment for an average term of approximately 48 months.

In addition, the Criminal Division also investigates and prosecutes corporate matters involving larger medical providers and companies.  As a result, the Criminal Division is involved in numerous corporate investigations initiated by False Claims Act lawsuits filed by qui tam relators or referrals from law enforcement agencies.  In a recent speech, the Assistant Attorney General made clear that addressing large-scale corporate health care fraud is a key Criminal Division priority.

For particular questions relating to specific conduct, you should seek the advice of counsel, or contact the Department of Justice with the information listed below.

CONTACT US REGARDING HEALTH CARE FRAUD

By Mail

Correspondence relating to incidents of health care fraud may be sent to:

Fraud Section, Criminal Division
U.S. Department of Justice
ATTN: Chief, Health Care Fraud Unit
950 Constitution Ave., NW
Washington, DC 20530

By Email
Joe Beemsterboer(ZZZlink sends e-mail), Chief, Health Care Fraud Unit
Dustin Davis(ZZZlink sends e-mail), Assistant Chief, Baton Rouge and New Orleans Strike Force
Ashlee McFarlane(ZZZlink sends e-mail), Assistant Chief, Houston Strike Force
Allan Medina(ZZZlink sends e-mail), Assistant Chief, Chicago and Detroit Strike Force
Sally Molloy(ZZZlink sends e-mail), Assistant Chief, Corporate Strike Force
Diidri Robinson(ZZZlink sends e-mail), Assistant Chief, Los Angeles Strike Force
Brendan Stewart(ZZZlink sends e-mail), Assistant Chief, Brooklyn Strike Force
Nicholas Surmacz(ZZZlink sends e-mail), Assistant Chief, Miami, and Tampa Strike Force

 

July 2017 indictments to date

July 2017

July 24, 2017; U.S. Attorney; Middle District of Florida
Owner Of Tampa Parathyroid Practice Agrees To Pay $4 Million To Resolve False Claims Act Allegations
Tampa, FL – Dr. James Norman, the owner and operator of James Norman, MD, PA, a/k/a James Norman, MD, PA Parathyroid Center, d/b/a Norman Parathyroid Center (collectively, Norman) has agreed to pay $4 million to resolve allegations that he violated the False Claims Act by knowingly engaging in various unlawful billing practices with respect to Medicare and other federal health care programs and their beneficiaries.
July 24, 2017; U.S. Attorney; Middle District of Tennessee
Pain Management Group Agrees To Pay $312,000 To Resolve False Claims Act And Overpayment Allegations
Pain Management Group P.C. (“PMG”), based in Antioch, Tenn., has agreed to pay $312,000 to settle federal and state False Claims Act and overpayment allegations, announced Jack Smith, Acting United States Attorney for the Middle District of Tennessee.
July 21, 2017; U.S. Department of Justice Medicare Fraud Strike Force Case
Houston Physician Convicted of Conspiracy in $1.5 Million Medicare Fraud Scheme
A federal jury convicted a Houston physician today for his role in a scheme involving approximately $1.5 million in fraudulent Medicare claims for home health care services and various medical testing and services.
July 21, 2017; U.S. Attorney; Middle District of Louisiana
Baton Rouge Home Health Company Settles False Claims Act Case For $1.7 Million
BATON ROUGE, LA – Acting United States Attorney Corey R. Amundson announced that CHARTER HOME HEALTH, a Baton Rouge-based healthcare company, has agreed to settle a civil fraud complaint filed under the federal False Claims Act by paying the United States $1.7 million and entering into a Corporate Integrity Agreement.
July 19, 2017; U.S. Attorney; Southern District of Florida
Nine Miami-Dade Assisted Living Facility Owners Sentenced to Federal Prison for Receipt of Health Care Kickbacks
Miami-Dade County assisted living facility owners, Marlene Marrero, 60, of Miami, Norma Casanova, 67, of Miami Lakes, Yeny De Erbiti, 51, of Miami, Rene Vega, 57, of Miami, Maribel Galvan, 43, of Miami Lakes, Dianelys Perez, 34, of Miami Gardens, Osniel Vera, 47, of Hialeah, Alicia Almeida, 56, of Miami Lakes, and Jorge Rodriguez, 57, of Hialeah, were sentenced to prison for receiving health care kickbacks. United States District Judge Marcia G. Cooke imposed sentences upon the nine defendants ranging from eight months to one year and one day, in prison. One assisted living facility owner, Blanca Orozco, 69, of Miramar, was sentenced to home confinement. In addition to their federal convictions, all ten defendants were also ordered to serve three years of supervised release, pay restitution and are subject to forfeiture judgments.
July 19, 2017; U.S. Attorney; Western District of Missouri
Two University of Missouri Physicians Plead Guilty to Health Care Fraud
JEFFERSON CITY, Mo. – Tom Larson, Acting United States Attorney for the Western District of Missouri, announced today that two physicians at the University of Missouri School of Medicine in Columbia, Mo., have pleaded guilty in federal court, in separate cases, to engaging in a health care fraud scheme that totaled more than $190,000.
July 18, 2017; U.S. Attorney; Western District of Virginia
Danville Doctor Pleads Guilty to Healthcare Fraud, Tax Evasion Charges
Danville, VIRGINIA – A Danville doctor, who billed various insurers for services he never administered to patients, pled guilty today in the United States District Court for the Western District of Virginia in Danville to healthcare fraud and tax evasion charges, Acting United States Attorney Rick A. Mountcastle announced.
July 17, 2017; U.S. Department of Justice
Three Companies and Their Executives Pay $19.5 Million to Resolve False Claims Act Allegations Pertaining to Rehabilitation Therapy and Hospice Services
Ohio based Foundations Health Solutions Inc. (FHS), Olympia Therapy Inc. (Olympia), and Tridia Hospice Care Inc. (Tridia), and their executives, Brian Colleran (Colleran) and Daniel Parker (Parker), have agreed to pay approximately $19.5 million to resolve allegations pertaining to the submission of false claims for medically unnecessary rehabilitation therapy and hospice services to Medicare, the Department of Justice announced today.
July 17, 2017; U.S. Attorney; Southern District of New York
Manhattan U.S. Attorney Announces $4.4 Million Settlement Of Civil Lawsuit Against VNS Choice For Improper Collection Of Medicaid Payments
Joon H. Kim, the Acting United States Attorney for the Southern District of New York, announced today that the United States has settled a civil fraud lawsuit against VNS CHOICE, VNS CHOICE COMMUNITY CARE, and VISITING NURSE SERVICE OF NEW YORK (collectively, “VNS”) for improperly collecting monthly Medicaid payments for 365 Medicaid beneficiaries whom VNS Choice failed to timely disenroll from the VNS Choice Managed Long-Term Care Plan (“Choice MLTCP”). Most of the beneficiaries who should have been disenrolled from the Choice MLTCP were no longer receiving health care services from VNS. Under the terms of the settlement approved today by United States District Judge Ronnie Abrams, VNS Choice must pay a total sum of $4,392,150, with $1,756,860 going to the United States and the remaining amount to the State of New York. In the settlement, VNS admits that VNS Choice failed to timely disenroll 365 Choice MLTCP members and, as a result, received Medicaid payments to which it was not entitled.
July 14, 2017; U.S. Department of Justice
Clinical Psychologist and Owner of Psychological Services Centers Sentenced to 264 Months for Roles in $25 Million Psychological Testing Scheme Carried out Through Eight Companies in Four States
Two owners of psychological services companies, one of whom was a clinical psychologist, were sentenced yesterday for their involvement in a $25.2 million Medicare fraud scheme carried out through eight companies at nursing homes in four states in the Southeastern U.S.
July 14, 2017; U.S. Attorney; Southern District of Georgia
Southern District Of Georgia Announces Participation in National Health Care Fraud Takedown
SAVANNAH, GA: On Thursday, Attorney General Jeff Sessions and Department of Health and Human Services (“HHS”) Secretary Tom Price, M.D., announced the largest ever health care fraud enforcement action by the Medicare Fraud Strike Force, involving 412 charged defendants across 41 federal districts, including 115 doctors, nurses and other licensed medical professionals, for their alleged participation in health care fraud schemes involving approximately $1.3 billion in false billings. Of those charged, over 120 defendants, including doctors, were charged for their roles in prescribing and distributing opioids and other dangerous narcotics.
July 14, 2017; U.S. Attorney; Eastern District of New York
Senior Executives Of Medical Drug Re-Packager Plead Guilty To Defrauding Healthcare Providers
Earlier today, in federal court in Brooklyn, Gerald Tighe, the president and owner of Med Prep Consulting Inc. (Med Prep), and Stephen Kalinoski, its director of pharmacy and registered pharmacist-in-charge, pleaded guilty to wire fraud conspiracy in connection with their operation of the now-defunct Tinton Falls, New Jersey-based medical drug re-packager and compounding pharmacy. The pleas were entered before United States District Judge I. Leo Glasser.
July 13, 2017; U.S. Department of Justice
National Health Care Fraud Takedown Results in Charges Against Over 412 Individuals Responsible for $1.3 Billion in Fraud Losses
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, including 115 doctors, nurses and other licensed medical professionals, for their alleged participation in health care fraud schemes involving approximately $1.3 billion in false billings. Of those charged, over 120 defendants, including doctors, were charged for their roles in prescribing and distributing opioids and other dangerous narcotics. Thirty state Medicaid Fraud Control Units also participated in today’s arrests. In addition, HHS has initiated suspension actions against 295 providers, including doctors, nurses and pharmacists.
July 13, 2017; U.S. Attorney; Northern District of New York Medicare Fraud Strike Force Case
Kinderhook Podiatrist Pleads Guilty to Health Care Fraud, Pays $410,000 to Resolve False Claims Act Liability
ALBANY, NEW YORK – Podiatrist Perrin D. Edwards, age 64, of Kinderhook, New York, pled guilty on Tuesday to health care fraud for illegally charging Medicare and private insurance companies for services that he never provided. Edwards has also paid $410,000 to the United States to resolve his civil liability for his submission of false claims for payment to the Medicare.
July 13, 2017; U.S. Attorney; Northern District of Illinois Medicare Fraud Strike Force Case
National Healthcare Fraud Takedown Results in Charges Against More Than 400 Individuals, Including Several Chicago-Area Medical Professionals
CHICAGO – Several Chicago-area medical professionals, including two licensed physicians, are facing federal criminal charges as part of the largest health care fraud enforcement action in Department of Justice history, federal authorities announced today.
July 13, 2017; U.S. Attorney; Southern District of Florida Medicare Fraud Strike Force Case
Seventy-Seven Charged in Southern District of Florida as Part of Largest Health Care Fraud Action in Department of Justice History
Benjamin G. Greenberg, Acting United States Attorney for the Southern District of Florida; George L. Piro, Special Agent in Charge, Federal Bureau of Investigation (FBI), Miami Field Office; Shimon R. Richmond, Special Agent in Charge, U.S. Department of Health & Human Services, Miami Regional Office, Office of Inspector General (HHS-OIG); and Pam Bondi, Florida Attorney General; announced today the largest ever health care fraud enforcement action by the Medicare Fraud Strike Force, involving 412 charged defendants across 41 federal districts, including 115 doctors, nurses and other licensed medical professionals, for their alleged participation in health care fraud schemes involving approximately $1.3 billion in false billings. In the Southern District of Florida a total of 77 defendants were charged with offenses relating to their participation in various fraud schemes involving over $141 million in false billings for services including home health care, mental health services and pharmacy fraud.
July 13, 2017; U.S. Attorney; Central District of California Medicare Fraud Strike Force Case
As Part of National Health Care Fraud Takedown, Federal Prosecutors in Los Angeles Charge 14 Defendants in Fraud Schemes that Allegedly Cost Public Healthcare Programs nearly $150 Million
LOS ANGELES – In the largest-ever health care fraud enforcement action by federal prosecutors, 14 defendants – including doctors, nurses and other licensed medical professionals – have been charged in the Central District of California for allegedly participating in health care fraud schemes that caused approximately $147 million in losses.
July 13, 2017; U.S. Attorney; Eastern District of Arkansas Medicare Fraud Strike Force Case
Twenty-Four Charged in Arkansas as Part of Largest Nationwide Health Care Fraud Enforcement Action in Department of Justice History
WASHINGTON-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-including the Eastern District of Arkansas. Among the defendants were 115 doctors, nurses and other licensed medical professionals, all alleged to have participated in health care fraud schemes involving approximately $1.3 billion in false billings. Of those charged, over 120 defendants, including doctors, were charged for their roles in prescribing and distributing opioids and other dangerous narcotics. Thirty state Medicaid Fraud Control Units also participated in today’s arrests. In addition, HHS has initiated suspension actions against 295 providers, including doctors, nurses and pharmacists.
July 13, 2017; U.S. Attorney; Northern District of Alabama Medicare Fraud Strike Force Case
U.S. Attorney Charges NW Alabama Compounding Pharmacy Sales Representatives in Prescription Fraud Conspiracy
BIRMINGHAM – The U.S. Attorney’s Office on Wednesday charged two sales representatives for a Haleyville, Ala.,-based compounding pharmacy for participating in a conspiracy to generate prescriptions and defraud health care insurers and prescription drug administrators out of tens of millions of dollars in 2015.
July 13, 2017; U.S. Attorney; Eastern District of Virginia Medicare Fraud Strike Force Case
Woman Indicted on Medicaid Fraud and Identity Theft Charges
RICHMOND, Va. – As part of the largest ever health care fraud enforcement action in Department of Justice History, a Richmond woman has been charged with healthcare fraud, aggravated identity theft, and making a false statement to federal agents.
July 13, 2017; U.S. Attorney; Middle District of Louisiana Medicare Fraud Strike Force Case
Baton Rouge-Based Medicare Fraud Strike Force Announces Charges Against Four More Individuals For Health Care Fraud And Related Offenses
BATON ROUGE, LA – Acting United States Attorney Corey R. Amundson announced today the unsealing of two federal grand jury indictments charging four individuals with health care fraud and related offenses. The cases were unsealed as part of the 2017 National Health Care Fraud Takedown, during which federal, state, and local law enforcement partners announced charges of more than 400 defendants across 41 different federal judicial districts.
July 13, 2014; U.S. Attorney; Southern District of Ohio Medicare Fraud Strike Force Case
National Health Care Fraud Takedown Includes Two Central Ohio Companies and Owners Charged with False Billing
COLUMBUS, Ohio – A federal grand jury has returned separate indictments charging two central Ohio health care companies and the people who own them with health care fraud. One company allegedly billed government insurance programs for unnecessary medical procedures and the other is accused of billing government insurance programs for pain and scar creams that recipients said they never requested or wanted.
July 13, 2017; U.S. Attorney; Northern District of California Medicare Fraud Strike Force Case
Charges Filed Against Northern California Physician For Unlawfully Dispensing Oxycodone
SAN FRANCISCO – Christopher Owens, a physician licensed to practice in California, was indicted on Tuesday with unlawfully prescribing oxycodone, announced U.S. Attorney Brian J. Stretch and Drug Enforcement Administration Special Agent in Charge John J. Martin. The indictment alleges that between September of 2012 and June of 2015, Owens, 50, now of Indianapolis, IN, intended to act outside the course of usual professional practice and without a legitimate medical purpose when he prescribed oxycodone on numerous occasions. In sum, Owens is charged with 36 counts of distributing oxycodone, in violation of 21 U.S.C. § 841(a)(1) and (b)(1)(C).
July 13, 2017; U.S. Department of Justice
Miami-Based Physician Pleads Guilty for Role in Pain Pill Diversion and Medicare Fraud Scheme
A licensed physician in Miami pleaded guilty in federal court yesterday for his role in a multi-faceted $4.8 million health care fraud scheme that ran from April 2011 to February 2017, involving the submission of false and fraudulent claims to Medicare and the illegal prescribing of Schedule II (e.g., oxycodone and hydrocodone) and Schedule IV (e.g., alprazolam) controlled substances.
July 12, 2017; U.S. Attorney; Southern District of Texas
Two Men Indicted in Medicare Fraud Scheme in Rio Grande Valley
McALLEN, Texas – A former laboratory technician at a medical clinic in Mission and an account representative for a toxicology testing company have been indicted in connection with a scheme to defraud Medicare, announced Acting U.S. Attorney Abe Martinez.
July 11, 2017; U.S. Attorney; Northern District of Texas
Woman Indicted for Running Health Care Fraud Scheme from Prison
DALLAS – Alexis C. Norman, 46, of Midlothian, Texas has been indicted on felony offenses stemming from a health care fraud conspiracy she ran from prison that involved the submission of more than $810,000 in false claims to Medicaid, announced U.S. Attorney John Parker of the Northern District of Texas.
July 11, 2017; U.S. Attorney; District of Connecticut
Drug Company Sales Rep Admits Role in Kickback Scheme Related to Fentanyl Spray Prescriptions
Deirdre M. Daly, United States Attorney for the District of Connecticut, announced that NATALIE LEVINE, 33, of Scottsdale, Arizona, waived her right to be indicted and pleaded guilty today before U.S. District Judge Michael P. Shea in Hartford to one count of engaging in a kickback scheme that defrauded federal healthcare programs.
July 10, 2017; U.S. Attorney; Southern District of New York
Brooklyn Pharmacy Owner/Operator Charged With Defrauding Medicare And Medicaid Programs Of Approximately $9 Million
Joon H. Kim, the Acting United States Attorney for the Southern District of New York, William F. Sweeney Jr., the Assistant Director-in-Charge of the New York Office of the New York Office of the Federal Bureau of Investigation (“FBI”), Scott J. Lampert, Special Agent in Charge of the New York Regional Office for the Department of Health and Human Services, Office of Inspector General (“HHS-OIG”), and Dennis Rosen, Inspector General of the New York State Office of the Medicaid Inspector General (“OMIG”), announced today the unsealing of a criminal Complaint charging defendant SUNITA KUMAR with operating a health care fraud scheme utilizing two pharmacies in Brooklyn, New York, through which KUMAR submitted approximately $9 million in fraudulent claims to Medicaid and Medicare. KUMAR was arrested this morning and was presented in Manhattan federal court today before U.S. Magistrate Judge Andrew J. Peck.
July 7, 2017; U.S. Attorney; Eastern District of California
Wal-Mart Pays $1.65M to Settle False Claims Act Allegations of Improper Medi Cal Billings
SACRAMENTO, Calif. – Wal-Mart Stores Inc. has paid $1.65 million to resolve allegations that it violated the federal False Claims Act when it knowingly submitted claims for reimbursement to California’s Medi Cal program that were not supported by applicable diagnosis and documentation requirements, U.S. Attorney Phillip A. Talbert announced today.
July 6, 2017; U.S. Attorney; Northern District of Georgia
Hospice to pay $2.4 Million to resolve False Claims Act Allegations
ATLANTA – Compassionate Care Hospice Group, Inc., (“CCH Group”) has agreed to pay $2.4 million to resolve allegations that CCH Group and its subsidiary Compassionate Care Hospice of Atlanta, LLC, (“CCH Atlanta”) submitted or caused the submission of false claims to Medicare and Medicaid by engaging in improper financial relationships with contracted physicians. CCH Group is a Florida corporation with its principal place of business in Parsippany, New Jersey, and subsidiaries and affiliates in numerous states.
July 6, 2017; U.S. Attorney; District of New Jersey
Hospice Company To Pay $2 Million To Resolve Alleged False Claims Related To Unnecessary Hospice Care
NEWARK, N.J. – A hospice company in Bensalem, Pennsylvania, has agreed to pay to the United States $2 million to resolve allegations that it provided unnecessary hospice services, Acting U.S. Attorney William E. Fitzpatrick announced today.
July 6, 2017; U.S. Attorney; Eastern District of Pennsylvania
Defunct Philly Hospice’s Owners/Operators to Pay Millions to Settle Civil False Claims Suit
PHILADELPHIA – Acting United States Attorney Louis D. Lappen announced today that Matthew Kolodesh, Alex Pugman, Svetlana Ganetsky, and Malvina Yakobashvili have agreed to pay millions of dollars to settle False Claims Act allegations that they and their now-defunct company, Home Care Hospice, Inc. (HCH), falsely claimed and received taxpayer dollars for hospice services that were either unnecessary or never provided. Previously, a federal jury found Kolodesh guilty on, and Pugman and Ganetsky pleaded guilty to, related criminal charges.
July 5, 2017; U.S. Attorney; Eastern District of Missouri
U.S. Reaches $8.3 Million Civil Settlement with Reliant Care Group and Reliant Affiliated Entities
St. Louis, Missouri: The United States Attorney’s Office for the Eastern District of Missouri announced today that the United States, Reliant Care Group, Reliant Care Management Company, Reliant Care Rehabilitative Services, and a number of Reliant affiliated skilled nursing facilities (Reliant) reached a civil settlement that will resolve the United States’ claims against Reliant under the False Claims Act for knowingly submitting false claims to Medicare for providing unnecessary physical, speech, and occupational therapy to nursing home residents.

Of course, Chicago only had one indictment, but it was the wort one ever:

July 13, 2017; U.S. Attorney; Northern District of Illinois Medicare Fraud Strike Force CaseNational Healthcare Fraud Takedown Results in Charges Against More Than 400 Individuals, Including Several Chicago-Area Medical Professionals
CHICAGO – Several Chicago-area medical professionals, including two licensed physicians, are facing federal criminal charges as part of the largest health care fraud enforcement action in Department of Justice history, federal authorities announced today.

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