U.S. completes 'takedown' of Medicare
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[June 23, 2016]
By Sarah N. Lynch
WASHINGTON (Reuters) - U.S. law
enforcement officials have charged 301 suspects with trying to defraud
Medicare and other federal insurance programs in 2016, marking the
"largest takedown" involving health care fraud allegations, the Justice
Department said on Wednesday.
The national sweep resulted in charges against doctors, nurses,
pharmacists and physical therapists accused of fraud that cost the
government $900 million, the department said.
The cases involved an array of charges, including conspiracy to
commit health care fraud, money laundering and violations of an
This year's sweep exceeded last year's record in which 243
defendants faced charges in a combined $712 million in government
losses. Officials said it was the largest takedown in the nine-year
history of the Medicare Fraud Strike Force, a joint initiative
between federal, state and local law enforcement.
Attorney General Loretta Lynch said some of the cases reflect new,
troublesome trends, including instances of identity theft in order
to prepare fake prescriptions and a growing number of cases
involving compounding, or the mixing of medications tailored to meet
a patient's needs.
Compounded medications are typically very expensive. From 2012 to
2014, the quarterly Medicare spending on these prescriptions
skyrocketed from $28 million to $171 million.
"As this takedown should make clear, health care fraud is not an
abstract violation or benign offense," Lynch said. "It is a serious
In one case, two owners of a group of outpatient clinics and a
patient recruiter stand accused of filing $36 million in fraudulent
claims for physical therapy and other services that were not
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Attorney General Loretta E. Lynch stands during the announcement of
law enforcement action against the state of North Carolina in
Washington, U.S., May 9, 2016. REUTERS/Joshua Roberts/File Photo
The Justice Department said that to find patients, the clinic
operators and the recruiter targeted poor drug addicts and offered
them narcotics so they could bill them for services that were never
Another case was filed against the operator of a marketing business
that received referral fees from pharmacies that filled and billed
Tricare, the U.S. military's government insurance program, for
The prescriptions were submitted via "telemedicine" sites, and
doctors were given blank prescription forms to fill out, regardless
of medical necessity, according to the complaint.
One doctor told the FBI her identity and medical credentials were
used without her permission to fill thousands of dollars worth of
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