National Healthcare Fraud Takedown Results In Charges Against 601 Individuals Responsible For $2 Billion In Fraud Losses

WASHINGTON - Attorney General Jeff Sessions and Department of Health and Human Services (HHS) Secretary Alex M. Azar III, announced today the largest ever health care fraud enforcement action involving 601 charged defendants across 58 federal districts, including 165 doctors, nurses and other licensed medical professionals, for their alleged participation in health care fraud schemes involving more than $2 billion in false billings.  Of those charged, 162 defendants, including 76 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 announced today that from July 2017 to the present, it has excluded 2,700 individuals from participation in Medicare, Medicaid, and all other Federal health care programs, which includes 587 providers excluded for conduct related to opioid diversion and abuse. 

Attorney General Sessions and Secretary Azar were joined in the announcement by Acting Assistant Attorney General John P. Cronan of the Justice Department’s Criminal Division, Deputy Director David L. Bowdich of the FBI, Assistant Administrator John Martin of the Drug Enforcement Administration (DEA), Deputy Inspector General Gary Cantrell of the HHS Office of Inspector General (OIG), Deputy Chief Eric Hylton of IRS Criminal Investigation (CI), Centers for Medicare and Medicaid Services (CMS) Deputy Administrator and Director of the Center for Program Integrity Alec Alexander and Director Dermot F. O’Reilly of the Defense Criminal Investigative Service (DCIS).

Today’s enforcement actions were led and coordinated by the Criminal Division, Fraud Section’s Health Care Fraud Unit in conjunction with its Medicare Fraud Strike Force (MFSF) partners, a partnership between the Criminal Division, U.S. Attorney’s Offices, the FBI and HHS-OIG.  In addition, the operation includes the participation of the DEA, DCIS, IRS-CI, Department of Labor, other various federal law enforcement agencies, and State Medicaid Fraud Control Units. 

The charges announced today aggressively target schemes billing Medicare, Medicaid, TRICARE (a health insurance program for members and veterans of the armed forces and their families), and private insurance companies for medically unnecessary prescription drugs and compounded medications that often were never even purchased and/or distributed to beneficiaries.  The charges also involve individuals contributing to the opioid epidemic, with a particular focus on medical professionals involved in the unlawful distribution of opioids and other prescription narcotics, a particular focus for the Department.  According to the CDC, approximately 115 Americans die every day of an opioid-related overdose.   

“Health care fraud is a betrayal of vulnerable patients, and often it is theft from the taxpayer,” said Attorney General Sessions.  “In many cases, doctors, nurses, and pharmacists take advantage of people suffering from drug addiction in order to line their pockets. These are despicable crimes. That’s why this Department of Justice has taken historic new steps to go after fraudsters, including hiring more prosecutors and leveraging the power of data analytics. Today the Department of Justice is announcing the largest health care fraud enforcement action in American history.  This is the most fraud, the most defendants, and the most doctors ever charged in a single operation—and we have evidence that our ongoing work has stopped or prevented billions of dollars’ worth of fraud. I want to thank our fabulous partners with the FBI, DEA, our Health Care Fraud task forces, HHS, the Defense Criminal Investigative Service, IRS Criminal Investigation, Medicare, and especially the more than 1,000 federal, state, local, and tribal law enforcement officers from across America who made this possible. By every measure we are more effective at finding and prosecuting medical fraud than ever.”

“Every dollar recovered in this year’s operation represents not just a taxpayer’s hard-earned money—it’s a dollar that can go toward providing healthcare for Americans in need,” said HHS Secretary Azar.  “This year’s Takedown Day is a significant accomplishment for the American people, and every public servant involved should be proud of their work.”

According to court documents, the defendants allegedly participated in schemes to submit claims to Medicare, Medicaid, TRICARE, and private insurance companies for treatments that were medically unnecessary and often never provided.  In many cases, patient recruiters, beneficiaries and other co-conspirators were allegedly paid cash kickbacks in return for supplying beneficiary information to providers, so that the providers could then submit fraudulent bills to Medicare.  Collectively, the doctors, nurses, licensed medical professionals, health care company owners and others charged are accused of submitting a total of over $2 billion in fraudulent billings.  The number of medical professionals charged is particularly significant, because virtually every health care fraud scheme requires a corrupt medical professional to be involved in order for Medicare or Medicaid to pay the fraudulent claims.  Aggressively pursuing corrupt medical professionals not only has a deterrent effect on other medical professionals, but also ensures that their licenses can no longer be used to bilk the system.

In Winamac, Indiana, two individuals involved with the operation of Transport Loving Care (also known as Alliance EMS) allegedly submitted false claims to Medicare and Medicaid. Michael Wilson and Jaqueline “Jay” Podell – allegedly claimed they provided transportation of recipients to dialysis by ambulance service when in fact the recipients were ambulatory, did not require ambulance transportation and were not eligible for ambulance transportation. The Indictment claims the loss to Indiana Medicaid is in excess of $10,000. Charges include conspiracy to commit health care fraud (Medicare); health care fraud (Medicare); Medicaid health care fraud; and forfeiture.

In Gary, Indiana, two individuals involved in the operation of Lending a Helping Hand Transportation -- Felicia Blount and Charlotte Hunter -- allegedly billed Indiana Medicaid for services not rendered, inflating mileage for trips from Northwest Indiana to Indianapolis by approximately 100 miles per trip. The total fraud to the Indiana Medicaid program is in excess of $100,000. The two defendants are charged with health care fraud and the indictment also seeks forfeiture.

In San Pierre, Indiana, four individuals involved in United Mobile Care – Edward Kerr, Brenda Kerr, Mark Estrada and Tammy Estrada – allegedly submitted false claims to the Medicare and Medicaid program. They allegedly claimed they provided transportation of recipients to dialysis by ambulance service when in fact the recipients were ambulatory, did not require ambulance transportation and were not eligible for ambulance transportation. The Indictment claims the losses in excess of $100,000. Charges include 1 count of conspiracy to commit health care fraud and 10 counts of health care fraud. 

US Attorney Kirsch said, “The defendants indicted in these cases are charged with stealing tax payer money by defrauding our health care funds.  The victims are the taxpayers.  Working with our law enforcement partners we will continue to investigate and prosecute perpetrators of these fraudulent schemes.”

"Health care fraud is a threat to this country, both in terms of the well-being of patients and the integrity of government health care programs,” said Lamont Pugh, Special Agent in Charge for the U.S. Department of Health & Human Services Office of Inspector General. “Our agents will continue to work with our law enforcement partners to ensure these criminals are held accountable for their actions.”

“Medicaid fraud leaves in its wake many victims,” Attorney General Hill said. “Any licensed providers who commit this offense are taking advantage of those for whom they are supposed to provide care, including the disabled and less fortunate who rely on Medicaid. In addition, they are also fleecing all taxpayers whose hard-earned money is used to fund these programs. The investigators and lawyers in our Medicaid Fraud Control Unit are doing good work to help bring lawbreakers to justice. At the same time, we respect the due process to which all are entitled, and all those who stand accused of this crime are certainly presumed innocent until a court finds otherwise.”

The cases announced today are being prosecuted and investigated by U.S. Attorney’s Offices nationwide, along with Medicare Fraud Strike Force teams from the Criminal Division’s Fraud Section and from the U.S. Attorney’s Offices in the Southern District of Florida, Eastern District of Michigan, Eastern District of New York, Southern District of Texas, Central District of California, Eastern District of Louisiana, Northern District of Texas, Northern District of Illinois, Middle District of Louisiana, and the Middle District of Florida; and agents from the FBI, HHS-OIG, DEA, DCIS, IRS-CI, Department of Labor, other various federal law enforcement agencies, and state Medicaid Fraud Control Units.

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.

Additional documents related to this announcement will shortly be available here:

https://www.justice.gov/opa/documents-and-resources-june-28-2018.

This operation also highlights the great work being done by the Department of Justice’s Civil Division.  In the past fiscal year, the Department of Justice, including the Civil Division, has collectively won or negotiated over $2 billion in judgements and settlements related to matters alleging health care fraud. 

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