The Justice Department announced today a significant health care fraud enforcement operation across Florida and Georgia, involving charges against a total of 67 individuals across four federal districts for their alleged involvement in various schemes to defraud Medicare and Medicaid. The conduct allegedly resulted in more than $160 million in fraudulent billings. Those charged included physicians as well as other medical and business professionals. In addition, in the state of Florida, 16 defendants, including one licensed mental health professionals, have been charged with defrauding the Medicaid program out of over $1.2 million. Florida’s Medicaid Fraud Control Unit (MFCU) investigated these cases.
The charges announced today aggressively target schemes alleged to have billed Medicare, Medicaid and private insurance companies for medically unnecessary services, such as home health, prescriptions drugs and durable medical equipment.
Today’s enforcement actions were led and coordinated by the Health Care Fraud Unit of the Criminal Division’s Fraud Section in conjunction with its Medicare Fraud Strike Force (MFSF) partners, a partnership among the Criminal Division, U.S. Attorney’s Offices, the FBI and U.S. Health and Human Services-Office of Inspector General (HHS-OIG). In addition, the operation includes the participation of various other federal law enforcement agencies and state MFCUs. The Centers for Medicare & Medicaid Services, Center for Program Integrity (CMS/CPI) also announced today that all appropriate administrative actions would be taken based on these charges.
“The defendants charged today allegedly bilked the American people to the tune of millions in fraudulent billings,” said Assistant Attorney General Brian A. Benczkowski of the Justice Department’s Criminal Division. “All Americans should stand with the Department as we fight the fight against these unscrupulous schemes in Florida, Georgia, and across the country.”
“Anyone who seeks to exploit our federal healthcare programs for personal gain and illicit profit should know that we will prosecute them to the fullest extent of the law,” said U.S. Attorney Maria Chapa Lopez for the Middle District of Florida. “The American people must have confidence in the healthcare services for which they pay and receive, and trust in those who administer them.”
“Health care programs provide vital services to Americans,” said U.S. Attorney Ariana Fajardo Orshan of the Southern District of Florida. “Those who perpetuate these pervasive health care fraud schemes steal taxpayer dollars from intended beneficiaries and threaten the viability of government programs. We commend the coordinated and continued efforts of our federal law enforcement partners to root out fraud and abuse in our healthcare system.”
“The drug dealer stereotype involves violent gang members peddling poison in our streets, but often the illicit dealers wear white coats and work in medical offices,” said U.S. Attorney Bobby L. Christine for the Southern District of Georgia. “People who violate medical oaths and ethical codes to turn illegal profits by fueling the opioid crisis will find prosecutors and investigators working tirelessly to swap their lab coats for prison uniforms.”
“Being a healthcare professional in the Medicare program is a privilege, not a right. When physicians and other healthcare providers put their own financial gain above patient well-being and honest billing of government health programs, they violate the basic trust that taxpayers extend to healthcare professionals,” said Special Agent in Charge Derrick L. Jackson of the HHS-OIG Atlanta Regional Office. “Today’s arrests put corrupt medical professionals on alert that law enforcement will do everything possible to root out all forms of waste, fraud and abuse in our federal health care programs.”
“FBI Atlanta and its Savannah Resident Agency are proud to have participated in this nationwide effort to help protect the much needed federal funds that Medicare provides,” said Special Agent in Charge Chris Hacker of the FBI’s Atlanta Field Office. “When providers are driven by greed and abuse the Medicare program, every tax paying citizen is a victim, especially those who use the federal funds for their health care needs. Improper billing inflates costs and the FBI and its law enforcement partners are determined to hold those who do it accountable.”
“The FBI and its federal, state and local partners are working tirelessly every day to detect and combat schemes like those announced today,” said Special Agent in Charge George L. Piro of the FBI’s Miami field office. “Despite our efforts, we still need the public’s help in reporting suspicious activity. If anyone suspects they are a victim of health care fraud please call your local FBI office or the HHS Office of Inspector General.”
“We commend the law enforcement partnerships for this operation and pledge to continue our commitment to protecting the nation’s federally funded healthcare system and the people who depend on it,” said Special Agent in Charge Michael McPherson of the FBI’s Tampa Division.