LOS ANGELES — The Justice Department on Thursday charged 15 people, including six medical professionals, in a Los Angeles-area health care fraud takedown involving more than $1.8 billion in fraudulent claims to government and private health care programs, the department said in a press release.
The largest part of the case is a scheme that allegedly billed more than $1.6 billion by luring vulnerable people to California for sham substance abuse treatment — the largest case of its type ever prosecuted by the department, according to the Justice Department. Prosecutors say another scheme fraudulently billed Medicare $134 million for unnecessary atherectomy procedures that resulted in injury to patients, and three hospice schemes billed more than $138 million for patients who were not terminally ill. A further defendant was indicted after previously being charged in a $270 million scheme to defraud Medi-Cal, California’s Medicaid program, through pharmacy claims for bogus prescriptions, the department said.
Eight defendants were arrested on Thursday, the department said, with initial appearances expected in federal court in downtown Los Angeles and in Texas. “These charges include the largest sober home fraud scheme the Department has ever prosecuted, and a scheme involving unnecessary invasive procedures detected through data analytics,” said Assistant Attorney General Colin M. McDonald of the department’s National Fraud Enforcement Division. “Our message is simple: if you steal health care dollars from the American taxpayer or abuse your position to harm patients, we are coming for you – and the data will lead us to wherever you are.”
Reporting based on the department’s release and court coverage described how the atherectomy case was flagged: a surgeon and his business partner allegedly billed Medicare about $135 million for procedures at two Los Angeles clinics, with billing patterns that data analytics identified as an extreme national outlier. In the hospice cases, a medical director is charged with signing false certificates of terminal illness for beneficiaries who in some cases did not know they had been placed on hospice, according to that reporting. Those details are allegations in charging documents, not findings of guilt.
Background: Thursday’s action follows a broader June crackdown in which the Justice Department charged 455 people in cases involving more than $6.5 billion in alleged false claims, and a May decision by the Centers for Medicare & Medicaid Services to impose a six-month nationwide moratorium on new hospice and home-health enrollments, citing fraud and program-integrity concerns.
Why it matters: health care fraud does not only cost taxpayers — in these cases, prosecutors say, patients were subjected to unnecessary invasive procedures, placed on hospice without their knowledge, or recruited into treatment that was never provided. Every defendant is presumed innocent unless and until proven guilty, and the cases will now move through initial appearances, detention decisions and evidence disclosure in federal court.
Read the primary source: the Justice Department press release.
