Feds tout largest Medicare fraud bust ever

Updated at 4:05 p.m. ET

WASHINGTON - A nationwide law enforcement crackdown has resulted in charges against 91 people — including doctors and other medical professionals — for what authorities described as the largest bust for Medicare fraud in U.S. history, allegedly participating in schemes involving $295 million in false billing.

"At various positions, nurses and physicians violated their professions as well as the public trust," Attorney General Eric Holder told reporters, saying that charges included kickback schemes and money laundering.

"The charges are based on a variety of alleged fraud schemes involving various treatments and services that were not medically necessary - and, oftentimes, were never even provided," said the attorney general.

Holder and Health and Human Services Secretary Kathleen Sebelius say charges were filed in Baton Rouge, La.; Brooklyn, N.Y.; Chicago; Dallas; Detroit; Houston; Los Angeles and Miami.

Eleven of the people charged were doctors, three were nurses and 10 were licensed health professionals.

Over half the defendants — 46 — and $160 million of the total in phony claims announced Wednesday came from South Florida, still leading the nation in Medicare fraud.

In Miami, U.S. Attorney Wifredo Ferrer said investigators noticed a new twist in which people who already were receiving Medicare disability checks were recruited with promises they could live in a halfway house in South Florida — as long as they agreed to receive mental health services they did not need. Many were addicted to drugs or alcohol, and some were homeless, and Ferrer said they would be threatened with eviction if they did not participate in the fraud scheme.

"They were already in the system. They were lured in by the promise of having housing. It was, `Come and have a fresh start in Miami,"' Ferrer said.

That particular scheme and other frauds, operated out of an entity called Biscayne Milieu, accounted for $50 million of the fraudulent Medicare claims, prosecutors said. It provided no legitimate services.

"It was a complete fraud," Ferrer said.

In Houston, two people were charged with fraud schemes involving $62 million in false claims for home health care and medical equipment. One defendant allegedly sold beneficiary information to 100 Houston-area home health care agencies. The home agencies used the information to bill Medicare for services that were unnecessary or never provided.

In Baton Rouge, La., a doctor, nurse and five other co-conspirators were charged with billing Medicare more than $19 million for skilled nursing and other home health services that were not necessary or never provided.

The attorney general said that those arrested are jeopardizing the integrity of the nation's health care system. Sebelius called the law enforcement initiative a powerful warning to those who would try to defraud taxpayers and Medicare beneficiaries.

(Last year, CBS' "60 Minutes" broadcast an interview with a Medicare scammer, who explained how easy it was to defraud the government.)

Medicare fraud: A $60 billion crime
Video: Watch the "60 Minutes" segment
Video: $90 billion a year?

[Maerzie]

But, there are lots of other Social Security rip-offs too by just regular , lazy people who don't want to support themselves. I would wager that HALF the Social Security Disability checks that go out each month are going to people no more "disabled" than you or I!! They just have a good story they like, they have convince their doctors of their "pain", or their "deafness", etc., and nobody ever comes back to take them off the program when the jig is up, or when their poor little backaches improve, etc. Lots of these people can do roofing jobs, etc. , in their "disabled" conditions to suppplement their dole form our tax money. I know several phonies right off the bat. Sometimes they accidentally "FORGET" their act.

[WALKINGLASS]

295 million ain't nothing but the tip of the ICEBERG.

[WALKINGLASS]

God tells U in Matthew 5:34-37 and James 5:12 that ANYONE that takes an OATH of ANY KIND is of the EVIL ONE but U put your lives in doctors hands instead of God's hands and LIE and say U don't.

ALL DOCTORS and NURSES R nothing but LEGALIZED DOPE DEALERS and U TRUST them to keep Ur HI and HAPPY with PILLS.

Even the MODERATORS of these comments don't want the TRUTH revealed. It will stop their joy because they love a PILL HI.

[WALKINGLASS]

295 million ain't nothing but the TIP of the ICEBERG.

[WALKINGLASS]

Once they get U hooked, he/she will be your friend the rest of your life for about $65.00 a visit for your prescription.

Ain't it good to BUY a friend or WHAT?

[wolfmann4u-2009]

social security and medicare are not entitlemrnts they are insurance as you pay for them

[Grandy62]

not only do I pay for my Medicare, I also pay 20% of what
Medicare doesn't pay for. Were any Medicare patiences being
charged anything. Medicare is diferent from Medicaid. Medicare is an ins and Medicaid is from the state.

[retiredgustav]

Tedsliver... Please cite your source and don't say rush limbaugh or glenn beck.

[wolfmann4u-2009]

You think you got fraud now just wait till Obama care kicks in

[Maerzie]

The ignorance evidenced in this comment is caused by the republican propaganda machine. The primary PURPOSE of Obamacare (a name we LOVE because Obama will be remembered forever) was to STOP the ease of Medicare fraud for all the helthcare and pharmaceutical corporations! THAT is the REASON they are slandering our new healthcare BECAUSE they know they will not be able to rip off as easily as they became used to! How GULLIBLE some people are to have fallen for their tricks! All these gullibles who BOUGHT that republican "scare story" better HOPE they never get any cancer that needs the $1000+ (per vial) of IV med for each treatment. Remember, the republicans are the MASTERS of SCARE TACTICS!! Remember all the "white powder" jokes under President Cheney?? But, there are only a tiny number of REAL Republicans (the ones with the multi-millons and billions, so they HAVE to con the ignorant into their schemes. How can only those FEW ever have enough votes for ANY election?? They need a huge batch of ignorant gullibles just for their votes. After that, "To heck with you. We already raped you of what WE needed!"

[Suppozo]

Sometimes when I get my ER bills I wonder if ive been scammed..
Got an ER bill then a seperate bill from a Doctor...living in Florida everyone is a scam artist. Its the new Nigeria.

[Maerzie]

You should get a bill from the hospital, a bill from the doctor, and then a bill from the radiologist, or whoever had to read the results of any of your tests. The problem with these radiologists is that they are so SLOW getting their bills out, you already FORGOT you had any xrays. The medications and dressings, etc. SHOULD be included in the Hospital charge for the E.R.

[Overruled1]

I hope the IRS has a few words and audit on everyone involved with the fraud to see how they did their taxes as well.
We need to recover as much as possible the funds that were lost to fraud.
They should all lose everything they own, and I'm sure that should include that florida home they keep for bankruptcy protection too.

[credibility2]

Why has it taken so long to start tackling this rampant fraud? Start also going after Social Security Disability and Medicaid fraud. Get rid of these individuals who are draining the system.

[Overruled1]

I'm sure the gloves are off now...

[Maerzie]

Because the ones ripping off are the super wealthy! Why would they rat on themselves?? They are the exact same ones paying for all the propaganda ads telling everyone how "BAD" Obamacare is!! Sure, it's bad.......for THEM!! It means the END of all their scams!

[notyrants]

Regulations are laws. Criminals don't like regulation and one of the best ways to attack the law is to attack the enforcement of it through underfunding.

Hang the criminals high on the public square. Vote yes for the republican death penalty and hang these crooks high on the public square.

[dianam1001]

Medicare Fraud is not a new concept it has been going on for years. It just appears that with the present fiscal crises we are finally learning to track it down and nip it in the bud. Making an example of these thieves is a great start. I have worked in the medical billing arena for 37 years and I spotted fraud across the board. I never submitted a bill I knew was fraudulent even when the physician or DME supplier insisted. I reminded them that my butt would also be in a sling. Yes, I lost a job or two along the way because of my ethics but I also held enough ammo to insure that most of my jobs were secure (AKA...I know where the bodies are hidden). My husband and I are now on Medicare, I scrutinize every EOMB. I know when a doctor is overchargind and I report a doctor who I believe is overcharging. There are certain parameters a doctor must document to bill for certain codes, if I know our visit did not meet those goals, I report it to Medicare. People need to be proactive. Pay attention to everything Medicare sends you. If you allow overcharging you are part of the problem, not the solution.

[retiredgustav]

This is why so many doctors were opposed to Obama in the last election.

[Maerzie]

EXACTLY, "retiredgustav"! Under Obamacare, they have a harder time trying to figure out HOW to RIP-OFF! NOTICE, it is all the millionaire doctors, hospital supply companies, pharmaceutical companies, nursing home corporations, etc., and congresspeople, who want everybody to HATE Obamacare! They LIKED their easy game!