25 Arrested After Medicaid Fraud Round Up in Washington, D.C.

Thursday, February 27, 2014
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

In a citywide takedown, 25 people, including operators of home care agencies, operators of nurse staffing agencies, office workers and personal care assistants in Washington, D.C., were all arrested for alleged Medicare fraud schemes. According to the U.S. Attorney's Office, these individual scams involved at least $75 million in fraudulent Medicaid payments. On February 20, 2014, more than 200 law enforcement agents with the Federal Bureau of Investigation's (FBI) Washington Field Office, U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG), Internal Revenue Service-Crime Investigation and the Inspector General for the District of Columbia executed search warrants at 10 locations and seized dozens of bank accounts and property as part of the raid.

Click here to read the press release from the U.S. Attorney's Office.

According to the U.S. Attorney's Office, these arrests mark the largest health care fraud takedown in the history of the city.


Reason Behind the Raid.

Prosecutors stated that the alleged schemes were not necessarily part of a unified conspiracy.  However, most of them involved fake claims for home care services. This category of Medicaid claims in the Washington, D.C. area has grown dramatically in the past eight years, from $40 million in 2006, to $280 million in 2013, according to the Washington Post. This spike in numbers allegedly caused authorities to begin investigating the possibility of illegal activity.


Schemes in Washington, D.C. Area at "Epidemic Levels."

According to The Washington Post, the investigations uncovered aggressive networks of fraudsters paying kickbacks to beneficiaries to manufacture false claims for nonexistent services. Common schemes involved defendants allegedly persuading patients to fake illness or injury so they could bill Medicaid for home care they did not receive. Some of those patients received kickbacks.

In one alleged scheme, the owner of three home care agencies, who was barred from participating in federal health care programs after her nursing license was revoked, is accused of collecting more than $75 million through the D.C. and Maryland Medicaid programs. Authorities say the owner used an alias to bill Medicaid. Authorities allegedly seized property from her worth millions of dollars, including 46 bank accounts, a 7,300 square-foot house and five luxury vehicles. Another alleged scheme involved a woman selling counterfeit home health care aide certificates.

According to U.S. Attorney Ronald Machen, "Medicaid fraud in the District of Columbia is at epidemic levels." To read the entire article from The Washington Post, click here.


Responding to a Medicaid Audit.

We have been consulted by many individuals, both before and after criminal convictions for fraud or related offenses. Should you find yourself, your facility, or your health practice the subject of a Medicaid audit by your state Medicaid agency or audit contractor, there are a few things you should know. To read a previous blog on tips for responding to a Medicaid audit, click here.


Contact Health Law Attorneys Experienced in Handling Medicaid Audits, Investigations and other Legal Proceedings.

Medicaid fraud is a serious crime and is vigorously investigated by the state MFCU, the Agency for Health Care Administration (AHCA), the Zone Program Integrity Contractors (ZPICs), the FBI, the Office of Inspector General (OIG) of the U.S. Department of Health and Human Services (DHHS). Often other state and federal agencies, including the U.S. Postal Service (USPS), and other law enforcement agencies participate. Don’t wait until it’s too late. If you are concerned of any possible violations and would like a confidential consultation, contact a qualified health attorney familiar with medical billing and audits today. Often Medicaid fraud criminal charges arise out of routine Medicaid audits, probe audits, or patient complaints.

The Health Law Firm’s attorneys routinely represent physicians, dentists, orthodontists, medical groups, clinics, pharmacies, assisted living facilities (AFLs), home health care agencies, nursing homes, group homes and other healthcare providers in Medicaid and Medicare investigations, audits and recovery actions.

To contact The Health Law Firm please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.


Comments?

What do you think of these large crackdowns on Medicare fraud? Do you think they work as a deterrent for others committing health care fraud? Please leave any thoughtful comments below.


Sources:

U.S. Attorney's Office. "More Than 20 People Arrested Following Investigations into Widespread Health Care Fraud in D.C. Medicaid Program." Federal Bureau of Investigation. (February 20, 2014). From: http://www.fbi.gov/washingtondc/press-releases/2014/more-than-20-people-arrested-following-investigations-into-widespread-health-care-fraud-in-d.c.-medicaid-program

Nuckols, Ben. "25 Charged in Fraud Involving Home Care in DC." The Washington Post. (February 20, 2014). From: http://wapo.st/1myDCeV


About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law.  He is the President and Managing Partner of The Health Law Firm, which has a national practice.  Its main office is in the Orlando, Florida, area.  www.TheHealthLawFirm.com  The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone:  (407) 331-6620.


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2/27/2014

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