30 Charged in $86 Million Health Care Fraud Takedown in Southern District of Florida

A total of 30 defendants have been charged with offenses relating to their alleged participation in various schemes to defraud Medicare, Medicaid and private insurance. Those charged include physicians as well as other medical and business professionals.

The charges announced involve schemes alleged to have billed Medicare, Medicaid and private insurance companies for medically unnecessary services, such as home health, prescriptions drugs, durable medical equipment and addiction treatment services.  The conduct allegedly resulted in more than $86 million in fraudulent billings.

Some of the health care fraud cases have been charged as part of the takedown are:

Substance Abuse Treatment:

3 individuals were each charged with conspiracy to commit health care fraud, wire fraud, health care fraud, conspiracy to commit money laundering and money laundering.  The defendants allegedly caused a substance abuse treatment facility  and several clinical laboratories to submit false and fraudulent claims to health insurance plans for addiction treatment services that were not provided as billed and laboratory tests that were not medically necessary.

Home Health:

A podiatrist was charged with conspiracy to defraud the United States and to receive kickbacks, conspiracy to commit health care fraud and wire fraud, and health care fraud, for allegedly accepting cash kickbacks in exchange for writing medically unnecessary home health prescriptions and participating in a scheme to submit claims to Medicare for relatively expensive foot procedures that he never performed, which allegedly caused a loss of approximately $7.7 million to the Medicare program.

An individual was charged by information with conspiracy to defraud the U.S. and the solicitation and receipt of kickbacks in connection with a federal health care program for allegedly receiving kickback payments for the referral of Medicare beneficiaries to a home health care center.

4 individuals were charged by indictment with conspiracy to commit health care fraud, wire fraud, and health care fraud.  The charges stem from the individuals' alleged roles in a scheme to defraud Part A of the Medicare program of more than $4 million by billing for home health services that were not rendered and paying kickbacks to patient recruiters in exchange for patient referrals.  2 of the defendants, who were allegedly not licensed to provide physical therapy, accepted payment from a licensed physical therapist, paid by their co-conspirators, in exchange for allegedly obtaining signed patient visitation forms from Medicare beneficiaries used to submit false and fraudulent claims.

2 individuals were charged by indictment with conspiracy to defraud the U.S. and the solicitation and receipt of kickbacks in connection with a federal health care program.  According to the indictment, the defendants participated in a conspiracy to solicit and receive kickback payments for the referral of Medicare beneficiaries to home health agencies.

An individual was charged by indictment with conspiracy to defraud the U.S. and the solicitation and receipt of kickbacks in connection with a federal health care program.  According to the indictment, the defendant participated in a conspiracy to solicit and receive kickback payments for the referral of Medicare beneficiaries to a home health care center.

2 individuals were charged with conspiracy to defraud the U.S. and the solicitation and receipt of kickbacks in connection with a federal health care program.  According to the indictment, the defendants participated in a conspiracy to use their company to solicit and receive kickback payments for the referral of Medicare beneficiaries to home health agencies.

2 individuals were charged by indictment with conspiracy to receive health care kickbacks, conspiracy to commit health care fraud, wire fraud, and receipt of kickbacks in connection with a federal health care program.  According to the indictment, a defendant was an administrator of an outpatient rehabilitation facility that purportedly provided therapy services to Medicare beneficiaries.  As part of the fraudulent scheme, he allegedly conspired with others to pay kickbacks and bribes for the referral of Medicare beneficiaries to the rehab facility so their information could be used to submit fraudulent claims to Medicare for services purportedly provided, regardless of whether the Medicare beneficiaries needed or received the services.

Private Insurance:

An individual was charged by indictment with health care fraud, conspiracy to commit health care, and wire fraud for allegedly submitting and causing the submission of claims, via interstate wires, totaling approximately $2.5 million that falsely and fraudulently represented that various health care benefits, primarily physical therapy, were medically necessary, prescribed by a doctor, and had been provided to insurance beneficiaries of Blue Cross Blue Shield.

An individual was charged by indictment with conspiracy to commit health care fraud, wire fraud, and health care fraud for allegedly recruiting and paying Comcast and Telemundo employees and referring those employees and/or the employees’ personal information to fraudulently bill Blue Cross Blue Shield, totaling approximately $800,500.

An individual was charged by indictment with conspiracy to commit health care fraud and wire fraud in connection with his role in a $2.1 million private insurance fraud scheme.  According to the indictment, submitted insurance claims that falsely represented that the benefits the defendant's clinic had billed insurance for were medically necessary, prescribed by a doctor, and had been provided to these beneficiaries.

Pharmacy:

2 individuals were charged by indictment with health care fraud, conspiracy to commit health care fraud, and wire fraud.  The defendants were the owners and operators of a retail pharmacy and allegedly submitted and caused the submission of claims, via interstate wires, which falsely and fraudulently represented that various health care benefits, primarily prescription drugs, were medically necessary, prescribed by a doctor and had been provided by the pharmacy to Medicare beneficiaries.  As a result of these false and fraudulent claims, Medicare prescription drug plan sponsors allegedly made payments funded by the Medicare Part D Program to the corporate bank accounts of the pharmacy in the approximate amount of at least $2.1 million.

2 individuals were charged by indictment with conspiracy to commit healthcare, wire fraud, and health care fraud for allegedly participating in a conspiracy to use their company to offer and pay kickbacks for the referral of Medicare beneficiaries to their pharmacy, and to submit false and fraudulent claims to Medicare for prescription drugs that were not provided to Medicare beneficiaries.

2 individuals who are the owners and operators of three pharmacies, were charged by indictment with conspiracy to commit health care fraud and wire fraud; conspiracy to defraud the United States and pay and receive health care kickbacks; and health care fraud for allegedly participating in a scheme to pay kickbacks and bribes to patient recruiters and to fraudulently bill Medicare drug plan sponsors for prescription medications.  The indictment alleges that, during the course of the fraudulent scheme, the defendants received approximately $5.3 million from Medicare drug plan sponsors for prescription medications that were medically unnecessary, never provided and/or never purchased by the defendants’ pharmacies.

Durable Medical Equipment:

2 individuals were charged by indictment with conspiracy to commit health care fraud and wire fraud, wire fraud, and money laundering for allegedly paying kickbacks and bribes to physicians in exchange for signing doctors’ orders, and that the defendants then sold the doctors’ orders to Medicare providers who used the orders to submit approximately $39 million in fraudulent claims to Medicare.

3 individuals were charged by indictment with conspiracy to commit healthcare fraud and wire fraud, conspiracy to defraud the United States and pay kickbacks, health care fraud, and payment of kickbacks for allegedly paying kickbacks and bribes in exchange for signed doctors’ orders for durable medical equipment, which the defendants used to fraudulently bill Medicare for over $23 million.  The indictment alleges that defendants sought to impede Medicare beneficiary’s ability to return durable medical equipment that they did not want or need to defendants’ companies, so that defendants could continue to bill Medicare for that durable medical equipment.