Nationwide Crackdown on Health Care Fraud Schemes
Federal officials have charged dozens of doctors, nurses, and business owners across Texas in a nationwide crackdown on health care fraud schemes totaling more than $14.6 billion, according to the U.S. Department of Justice.
It is the largest operation of its kind in U.S. history, the Justice Department said in a news release this week.
Allegations and Charges
Four individuals — Demitrious Gilmore, 46, of Lubbock; Gary Martin, 62, of McKinney; Olatunbosun Osukoya, 67, of Plano; and Khadeer Khan Mohammed, 44, of Richardson — are accused of submitting about $210 million in false medical claims to government health programs and private insurers, according to the release.
These cases include allegations of billing for unnecessary medical equipment, fake physical therapy, genetic testing that was never performed, and illegal kickbacks for COVID-19 test referrals.
International Fraud Rings
Twenty-nine people are accused of running international fraud rings that submitted more than $12 billion in fake health insurance claims, the release says.
“This record-setting Health Care Fraud Takedown delivers justice to criminal actors who prey upon our most vulnerable citizens and steal from hardworking American taxpayers,” said U.S. Attorney General Pamela Bondi.
Arrests and Investigations
Some suspects were arrested trying to leave the country, and others were caught working with foreign partners to steal and sell patient information, the release said.
“These individuals lined their own pockets, egregiously stealing beneficiaries’ identities and pillaging the coffers of federal programs,” said Nancy Larson, acting U.S. Attorney for the North District of Texas.
Other Cases and Charges
In Arizona and Nevada, seven people — including five medical professionals — are charged with billing Medicare for unnecessary wound treatments, often targeting elderly and hospice patients.
Seventy-four people, including 44 medical professionals, are accused of illegally distributing more than 15 million opioid pills. In Texas, five people tied to one pharmacy allegedly distributed over 3 million pills.
Forty-nine people are charged with submitting over $1.17 billion in fake claims for telemedicine and genetic tests. In many cases, patients never requested or received the services.
One hundred seventy more defendants are accused of various schemes, from billing for unneeded medical tests to stealing prescription drugs meant for patients.
Consequences and Prevention
“The perpetrators of this fraud used deceptive tactics and their access to beneficiary information to profit off government-sponsored health insurance programs personally. These programs provide critical care and services to individuals in our communities who need it most,” FBI Dallas Special Agent in Charge Joe Rothrock said.
Authorities seized over $245 million in cash, cars, cryptocurrency, and other assets.
The government also prevented over $4 billion from being paid out in false claims and suspended or revoked the billing privileges of more than 200 health care providers. Civil charges and settlements were announced against dozens of defendants.
Officials say they are creating a new Health Care Fraud Data Fusion Center to help agencies share information and utilize advanced technology to detect and prevent fraud even more efficiently.
Conclusion
The nationwide crackdown on health care fraud schemes is a significant step towards protecting the integrity of the healthcare system and preventing further abuse. The allegations and charges brought against dozens of individuals and organizations highlight the need for continued vigilance and cooperation between law enforcement agencies and healthcare providers.
Frequently Asked Questions
Q: What is the total amount of health care fraud schemes charged in the nationwide crackdown?
A: The total amount of health care fraud schemes charged is over $14.6 billion.
Q: How many people are accused of running international fraud rings?
A: Twenty-nine people are accused of running international fraud rings that submitted more than $12 billion in fake health insurance claims.
Q: What is the purpose of the new Health Care Fraud Data Fusion Center?
A: The purpose of the new Health Care Fraud Data Fusion Center is to help agencies share information and utilize advanced technology to detect and prevent fraud even more efficiently.
Q: How much money was seized by authorities in the crackdown?
A: Authorities seized over $245 million in cash, cars, cryptocurrency, and other assets.
