September 7th, 2011
03:19 PM ET

Justice Department charges 91 in $295 million Medicare fraud scheme

The Justice Department on Wednesday announced charges against 91 people including doctors, nurses and other medical professionals allegedly involved in a nationwide Medicare fraud scheme in eight cities totaling $295 million in false billing.

“The defendants charged in this takedown are accused of stealing precious taxpayer resources and defrauding Medicare – jeopardizing the integrity of our health care system and our nation’s most critical health care program for personal gain,” Attorney General Eric Holder said in a press release. “Our highly coordinated, nationwide Strike Force operations are working aggressively to combat Medicare fraud and our anti-health care fraud efforts have never been more innovative, collaborative, aggressive – or effective. We will continue to work with our law enforcement partners and partners across government to fight against health care fraud.”

According to the Justice Department those charged are accused of a variety of fraud-related crimes including conspiracy to defraud the Medicare program, health care fraud, violations of the anti-kickback statutes and money laundering. The scheme involved home health care, physical and occupational therapy, mental health services, psychotherapy and durable medical equipment services, the Justice Department said.

“Today’s arrests are a powerful warning to those who would try to defraud taxpayers and Medicare beneficiaries,” Health and Human Service Secretary Kathleen Sebelius said in a press release. "These arrests illustrate close cooperation between the Medicare program that identified these fraudsters and the law enforcement officials who acted swiftly to cut them off. And our efforts to stop criminals don’t end here because the Affordable Care Act gives us new tools to prevent Medicare fraud before it is committed – better protecting seniors and the integrity of the Medicare program for generations to come.”

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  1. Kabel

    So now that we and our buddies have raided the piggy bank, lets just shut it down. I mean after all we are talking about Doctors, Lawyers and MBA's, after all we aren't real criminals, right?

    September 7, 2011 at 4:28 pm | Report abuse |
    • Hinterarsch

      Yes these Dr.'s Lawyers and MBA's are real criminal. I am glad we have 95 of them now buit we need to catch the rest of them. We need the defense contractors who have robbed the government in Iraq and Afganistan too.

      September 7, 2011 at 4:37 pm | Report abuse |
  2. JodeMuffin

    The State of Texas doesn't allow for children under 12 to get full orthodontic treatment. HOWEVER, last year alone, over 18,000 children under 12 got braces in the state thanks to Medicare abuse. WFAA has a great article detailing the corruption. Google 'Smiley Dental' and WFAA.

    September 7, 2011 at 4:29 pm | Report abuse |
    • Caight

      BTW, Medicare does not pay for medical or dental services for any 12 yo – you may be referring to Medicaid?

      September 7, 2011 at 4:45 pm | Report abuse |
  3. Dana

    They've been charged, not convicted - don't believe everything you read. Probably a lot of scapegoats.

    September 7, 2011 at 4:29 pm | Report abuse |
    • Elaine Connelly

      You are correct they have been apprehended, not charged, but I believe most of them are probably guilty as He** Most of the doctors I have had dealings with, are not completely honest as far as the ethics matter is concerned. They live in the most expensive houses. Have multiple homes, boats, cars, toys, and trophy wives. I went in for my physical and was charged almost $300 for a shingles vaccine shot. NOW YOU TELL ME THERE ISN'T ANYTHING CROOKED ABOUT THAT!

      September 7, 2011 at 4:33 pm | Report abuse |
    • JB

      But if they were black you'd be ready to convict, right?

      September 7, 2011 at 4:36 pm | Report abuse |
    • tati

      JB -How do you know that none of them is black? Why do people always have to bring race into everything?

      September 7, 2011 at 4:41 pm | Report abuse |
  4. James

    Anytime the government makes such proclamations, it usually lacks real evidence.

    I have no faith in Mr Holder, Mr not enforce the marriage act, Mr not enforce immigration laws, Mr lets dismiss complaints against Black Panthers and some union hired thugs, Mr not enforce drug laws, Mr lets declare legal war against our US States who try to protect their citizens from illegals and Mr lets give guns to mexican gangs.

    Sure Medicare and Medicaid fraud can occur, but it is usually the government ripping off the doctors and hospitals, by constantly making complicated schemes to prevent paying the bill. Occasionally Medicare just says, we won't pay for that level of service anymore. So medicare can simply deny payment on a months hospital stay of a critically ill patient, because someone could not get a complete smoking history or how many kids a person had (funny how unconscious patients don't talk much) and that is OK?

    Do you know if someone spends a month in intensive care unit (ICU), then goes to aregular floor a few days, then has a fall on his last day in the rehab unit, Medicare will deny payment for everything? How do you think those lost medical costs are made up, typically by again raising prices.

    The government and insurers play a thuosand games to avoid paying their bills or paying less and all is fair, but any simple error a hospital, doctor or other healthcare provider make is a crime.

    You will notice that since the government became aggressively involved in healthcare the price has gone up dramatically. We now use a larger percentage of a larger GDP on healthcare. The reality is that all the government over regulation drives the cost of medicine higher than need be.

    And if you give a worker who is uninsured a break on his bill, you are a criminal according to Medicare rules, because you charged someone less (not how much they paid, how much you charged). Yes charging a patient $40 and collecting $40 is a crime if you charge the government $100 and get paid $10 for the same care. The government saves $30 and sues for fraud.

    Now you know why there is a less Americans going into medicine.

    September 7, 2011 at 4:30 pm | Report abuse |
    • buddget


      September 7, 2011 at 4:37 pm | Report abuse |
    • Elaine Connelly

      There are plenty of Americans becoming doctors. Who do you think buys the big houses that no one else can afford. Here in Lincoln, NE, we are surrounded by urban sprawl. Doctors buy farms and then turn valuable farm land into a subdivision and make more money. Doctor's payments for office calls are now in the neighborhood of $100, just to get into the door. No excuse for that much to be charged. I make the grand sum of $13.98 an hour after 25 years of employment at the University of Nebraska-Lincoln.

      September 7, 2011 at 4:40 pm | Report abuse |
    • trupti

      Eric Holder did not say he wouldn't enforce the marriage act. He said the justice department would not defend it in court against challenges.

      September 7, 2011 at 4:47 pm | Report abuse |
  5. the prophet

    I see alot body bags

    September 7, 2011 at 4:31 pm | Report abuse |
  6. justathought

    Now they need to start on illegals, this was only $295 million, just think of what the illegals are costing this country–$90 BILLION+ in Calif alone. Kind'a makes $295M look a little insignificant.

    September 7, 2011 at 4:32 pm | Report abuse |
  7. Edard Stark

    Remember the biggest Medicare fraud ever. Committed by Columbia/HCA under the leadership of then CEO, our current Florida Governor Scott. Columbia/HCA admitted and fined over a Billion U.S. Dollars.

    September 7, 2011 at 4:32 pm | Report abuse |
  8. NoTags

    Theiving doctors are not necessarily foreign born. Back in the 90's I lived in a small town in FL where one of the local doctors who as I recall was originally from the Jacksonville, FL area was convicted of Medicare fraud and got 8 years. Lol, his practice was moved to a Federal jail.

    September 7, 2011 at 4:32 pm | Report abuse |
  9. FU_RED

    Whaaaaaa they are not Mexicans? They have tobe Mexicans... Those dam Mexicans are now Arbanians.... They are geniouses!!!!

    September 7, 2011 at 4:32 pm | Report abuse |
  10. Sal

    I don't know who are the bigger crooks. The government or us.

    September 7, 2011 at 4:33 pm | Report abuse |
  11. fiskenmann

    Who has been charged?

    September 7, 2011 at 4:34 pm | Report abuse |
  12. Sal

    We all need to stop paying taxes and just take care of our own. You can't trust the crooks or the government and if we stop financing one the other will disappear in no time. This country did fine before income tax.

    September 7, 2011 at 4:35 pm | Report abuse |
  13. buddget

    Money grubbing a__holes, and I am sure there are plenty more out ther. Because it's all about the money. Money, money money, show me the money!

    September 7, 2011 at 4:36 pm | Report abuse |
  14. fred ca

    When will these people learn. If they want money for nothing give a contribution to Dems and start a 'green' 'business'. Or be a slumlord and back the right Dem bagman. Or practice tax fraud and become an obama cabinet member. You'll get holder covering your butt and not chasing you.

    September 7, 2011 at 4:38 pm | Report abuse |
  15. Marion

    It's about damned time they did something about Medicare fraud. Now, if they only go after Organized Crime and the fraud schemes they cook up to defraud Medicare, Medicaid,, and probably Social Security too. (maybe this scheme involved
    Organized Crime ....I would not be surprised. But we will never really know, will we?)

    September 7, 2011 at 4:40 pm | Report abuse |
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