Feds: More Than 300 Charged In Health Care Fraud

June 28, 2016

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Source: USA Today

Doctors, nurses and pharmacists were among more than 300 charged with health care fraud schemes involving $900 million in false billings in what the Justice Department described Wednesday as the largest such enforcement action in U.S. history.

At least 28 doctors were among those charged with a range of offenses, including conspiracy, bribery, money laundering, kickback violations and identity theft, according to federal documents.

Sixty suspects were allegedly linked to schemes involving the Medicare prescription drug benefit program known as Part D, which is the fastest-growing component of the Medicare program overall.

“The wrongdoers that we pursue in these operations seek to use public funds for private enrichment,” Attorney General Loretta Lynch said Wednesday. “They target real people — many of them in need of significant medical care. They promise effective cures and therapies, but they provide none.”

According to court documents, the suspects allegedly submitted claims to Medicare and Medicaid for treatments that were medically unnecessary and often never provided.

In many cases, federal prosecutors alleged, patient recruiters, Medicare beneficiaries and other conspirators were paid kickbacks in return for supplying beneficiary information to providers, so that the providers could then submit fraudulent bills to Medicare for services that were medically unnecessary or never performed.

Lynch said one group of suspects used a combination of bribery and kickbacks to fill a network of clinics they operated in Brooklyn. The clinic’s patients later received “medically unnecessary treatment,” while the operators allegedly received $38 million in reimbursements from Medicare and Medicaid. Those funds, the attorney general said, were subsequently “laundered” through more than 15 shell companies.

Several of the shell firms, according to court documents, were operated by Aleksandr Pikus under the name “Pikus Companies.

Pikus, who was released on $800,000 bond, and four others all pleaded not guilty.

The five defendants are due back in a Brooklyn court Wednesday.

In Houston, meanwhile, physician John Ramirez was indicted on four conspiracy counts related to his alleged role in fraudulent billings totaling $38 million.

Ramirez, according to the documents, conspired with dozens of home health care companies, which authorized services for hundreds of Medicare beneficiaries that were either not necessary or never rendered.

The doctor also has pleaded not guilty.

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