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
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.
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
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
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
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
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
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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