Feds Announce Largest Ever Criminal Medical Fraud Takedown

By Serena Elavia Features FOXBusiness

Attorney General Loretta E. Lynch and the Department of Health and Human Services (HHS) Secretary Sylvia Matthew Burwell announced yesterday the largest ever healthcare fraud takedown.

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The government claimed that those involved billed Medicare and Medicaid for medically unnecessary treatments, or treatments never provided. A total of 243 individuals were charged including 46 doctors, nurses and other licensed medical professionals for a total of $712 million in fraudulent billing.

Over 44 of the defendants were charged with fraud related to the Medicare prescription drug benefit program, also known as Part D.

Here’s a by the numbers breakdown of where Medicare and Medicaid fraud occurred.  

  • 1. Miami, FL

    Miami, FL


    Number of Individuals Charged: 73

    Total Fraudulent Amount: $263 million

    Miami had the highest number of offenses of false billings for mental health services, pharmacy fraud and home health care.

  • 2. Texas


    Number of Individuals Charged: 22

    Total Fraudulent Amount: $38 million

    Texas had the next highest number of individuals charged for cases in Houston, McAllen and Dallas. For example, one physician house call company submitted approximately $43 million in claims for one doctor regardless of whether or not the service was provided by him or her.  

  • 3. Los Angeles, CA

    Los Angeles, CA


    Number of Individuals Charged: 8

    Total Fraudulent Amount: $66 million

    In Los Angeles, one case involved a doctor who allegedly caused $23 million in losses to Medicare because of fraudulent billing.


  • 4. Detroit, MI

    Detroit, MI

    Number of Individuals Charged: 16

    Total Fraudulent Amount: $122 million

    In Detroit, numerous individuals face charges for alleged roles in fraud and money laundering. For instance, owners of a hospice service allegedly paid kickbacks for referrals made by doctors who defrauded Part D by prescribing unnecessary prescriptions.

  • 5. Tampa, FL

    Tampa, FL


    Number of Individuals Charged: 5

    Total Fraudulent Amount: $ 1 million

    Alleged healthcare fraud schemes in Tampa included false physical therapy bills and billing for medical tests that never happened.

  • 6. Brooklyn, NY

    Brooklyn, NY


    Number of Individuals Charged: 9

    Total Fraudulent Amount: $58 million

    Two separate cases in Brooklyn involve physical and occupational therapy schemes.

  • 7. New Orleans, LA

    New Orleans, LA


    Number of Individuals Charged: 11

    Total Fraudulent Amount: $110 million 

    And in New Orleans, individuals were charged in a home health care and psychotherapy scheme for allegedly sending talking glucose monitors to individuals regardless of whether they needed them or not.

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