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$712 million Medicare Fraud Takedown – Largest Medicare Fraud Case in History Names 73 from Florida and 16 from Michigan

Yesterday the Department of Justice (DOJ) announced a $712 million Medicare Fraud takedown by the Medicare Fraud Strike Force. It is the largest criminal health care fraud takedown in history, both in terms of loss amount and number of defendants charged. Among the 243 individuals charged, 73 were from Miami Florida and 16 from Detroit Michigan.   The Washington Post (6/19, Horwitz) reports that this is the “single largest crackdown” in Justice Departments  eight-year campaign against health care fraud.  The USA Today (6/19, O’Donnell) reports that HHS Secretary Sylvia Burwell said, “the agency is being more proactive about rooting out Medicare fraud, including by doing more checking on providers ‘at the front end’ before they can bill Medicare for services.”  The ACA bolstered the anti-fraud effort by pumping $350 million into fraud prevention and enforcement. The number of Defendants from Miami, Florida continues to bolster the argument that Miami is the epicenter of Medicare fraud.

In recent years, there has been a significant increase in the amount of Medicare Fraud charges brought against physicians, home health care agencies, chiropractors, dispensaries, pharmacists, etc. This is largely due to the increase in enforcement.  The multi-tiered federal and state task force takes their mission seriously and is using a multitude of electronic and other sophisticated investigative techniques to locate and investigate the possibility of fraud.

It’s important to note the combination of Anti-Kickback statutes, False Claims Act, and Stark laws provide the government with a powerful tool to cast a very broad net.  While Anti-Kickback statutes require intent, the intent element is minimal, and non-existent with Stark and False Claims Act allegations.  Combining these statutes with the OIG Civil Monetary Penalty (CMP) provisions and the Cooperate Integrity Agreement (CIA) penalty or total exclusion provides the government with a powerful weapon to fight fraud.

Unfortunately fraud is a serious problem and whenever there is fraud it casts a shadow on the hundreds of thousands of health care professionals that are honest and do a good job following often very difficult conditions of payment established by CMS. Physicians, pharmacists, chiropractors, home health agencies and other health professionals accused of Medicare fraud, or other types of health care fraud, should seek legal assistance immediately. The Medicare Fraud Strike Force  and CMS are cracking down.  Health professionals charged with Medicare Fraud face significant criminal ( 5 years for each violation) and civil penalties ($25,000 fine per violation, treble damages, and penalties), plus potential exclusion from participation in billing any government program or placement on the corporate integrity watch list.

Chapman Law Group has the necessary resources and skills to walk you through the very complicated arena of Medicare fraud and health care fraud.  Your counsel must be knowledgeable in criminal law as well as health care law and conditions of payment and/or participation.  Health care law in general is stacked in layers and changes weekly.  A violation of one statute often triggers 3, 4 or more violations of other statutes as well as professional licensing actions and possible revocation and exclusion.  Do not hesitate to call Chapman Law Group.