5 Fast Facts: The Largest Health Care Fraud Bust in History

By Alexis Evans | June 23, 2016

The U.S. Department of Justice announced Wednesday it is charging hundreds of individuals across the country with committing health care fraud worth hundreds of millions of dollars, in what is being hailed the largest health care fraud bust in U.S. history. Here are the five fast facts you need to know.

1. 301 People Charged in Health Care Fraud Bust

The bust resulted in the takedown of 301 individuals, including 61 licensed medical professionals, 28 of whom were doctors. The charges include various health care fraud-related crimes, including conspiracy to commit health care fraud, violations of the anti-kickback statutes, money laundering, aggravated identity theft, and Medicare Part D pharmacy fraud.

Attorney General Lynch called out the alleged perpetrators in the release saying,

They target real people – many of them in need of significant medical care.  They promise effective cures and therapies, but they provide none.  Above all, they abuse basic bonds of trust – between doctor and patient; between pharmacist and doctor; between taxpayer and government – and pervert them to their own ends.

2. $900 Million in False Billings

The DOJ found the defendants to be responsible for a total of $900 million in false billings. The largest portion of fraudulent billings was traced to Florida, where a total of 100 defendants were charged for their involvement in approximately $220 million in false billings for home health care, mental health services and pharmacy fraud. According to the release,

In one case, nine defendants have been charged with operating six different Miami-area home health companies for the purpose of submitting false and fraudulent claims to Medicare, including for services that were not medically necessary and that were based on bribes and kickbacks.  In total, Medicare paid the six companies over $24 million as a result of the scheme.

Defendants in California, Texas, and Michigan are charged with committing more than $100 million worth of fraud in each state.

3. This Was a Joint Effort

Medicaid Fraud Control Units in 23 states and the Medicare Fraud Strike Force in 36 federal districts coordinated with the Justice Department and the Department of Health and Human Services in  the “unprecedented nationwide sweep.”

National Health Care Fraud Takedown Results https://t.co/LQk9OJpzKN pic.twitter.com/HMVFxvFrgd

— Justice Department (@TheJusticeDept) June 22, 2016

The Medicare Fraud Strike Force operations are part of the Health Care Fraud Prevention & Enforcement Action Team (HEAT), a joint initiative announced in May 2009 between the DOJ and HHS to help prevent waste, fraud, and abuse in the Medicare and Medicaid programs.

4. New Study Identifies 27 Home Health Care Fraud “Hotspots”

The U.S. Health & Human Services Office of Inspector General released a new study in conjunction with the DOJ’s arrests citing 27 geographical “hotspots” in 12 states where health care fraud is committed most often.

Eye on Oversight: OIG identified 27 hotspots for probable home health fraud. Watch the VIDEO. https://t.co/1KPY9RQe6D

— OIG at HHS (@OIGatHHS) June 21, 2016

The states include Arizona, California, Florida, Illinois, Louisiana, Michigan, Nevada, New York, Oklahoma, Pennsylvania, Texas, and Utah.

5. This Recent Bust Helped Pad Federal Authorities’ Record

Since its launch in March 2007, the Medicare Fraud Strike Force has charged over 2,900 defendants who collectively have falsely billed the Medicare program for over $8.9 billion. Wednesday’s announcement marks the second time that districts outside of Strike Force locations participated in a national health care fraud bust, and they accounted for 82 defendants charged in this takedown.