Over 100 People Busted For Medical Fraud
May 3, 2012

Over 100 People Busted For Medical Fraud

Connie K. Ho for Redorbit.com

$450 million. That´s the amount that has been received in false billings by a group of more than 100 schemers. The fraud has cost the U.S. government between $60 to $90 billion each year, according to the Associated Press (AP).

“This coordinated takedown involved the highest amount of false Medicare billings in a single takedown in strike force history,” the Justice Department noted in a prepared statement.

CNN reports that officials from the Justice Department and the Department of Health and Human Services are charging the defendants with making false claims against the Medicare program, including committing conspiracy, conducting health care fraud, and laundering money. Nurses, social workers, therapists, and a pharmacist were part of the people arrested. The road to the investigations began in 2009, when Kathleen Sebelius of Health and Human Services teamed up with Attorney General Eric Holder to increase enforcement and combat medical fraud in hot spots.

“Today´s arrests send a strong message to criminals that the consequences of committing Medicare fraud are serious,” remarked Sebelius in a prepared statement. “In addition to these arrests, we used new authority from the health-care law to stop all future payments to 52 health-care providers suspected of fraud.”

Finding cracks like these and suspending unnecessary payments is part of the plan to help pay for Obama´s health care plan.

“When President Obama took office he asked Attorney General Holder and me to make fraud prevention a cabinet-level priority,” Sebelius commented in a news conference in Washington D.C.

Top law enforcement officials have been working on the investigation for months in seven metropolitan cities, according to CNN. 91 of the defendants were taken into custody and 20 search warrants were executed for efforts to defraud Medicare, Medicaid, and other federal medical programs. The seven cities involved in the investigation included Baton Rouge (seven charged), Chicago (one charged), Detroit (22 charged), Los Angeles (eight charged), Miami (59 people charged),  and Tampa (one charged). Authorities believe that a scheme of community mental health centers in Baton Rouge was the largest, billing a total of $225 billion in their scams.

“The results we are announcing today are at the heart of an administration-wide commitment to protecting American taxpayers from health care fraud,” said Attorney General Eric Holder in the AP article. “We are determined to bring to justice those who violate our laws and defraud the Medicare program for personal gain.

The Baton Rouge mental health centers were run by Hoor Naz Jafri and Roslyn F. Dogan. The two owners recruited the elderly, the mentally ill, and drug addicts. They then filled out patient charts and billed Medicare, but never treated the patients or gave them the services they needed.

“These fraud schemes were committed by people up and down the chain of health-care providers -- from doctors, nurses and licensed clinical social workers to office managers and patient recruiters,” explained Assistant Attorney General Lanny A. Breuer at a press conference that was reported by Bloomberg.

Over the years, the scams have become more and more complex. Patient recruiters are paid kickbacks for recruiting patients. Doctors, nurses, and company owners are organized to make it look like the services were provided for the patients. As such, the federal government has been criticized for being one step behind of crooks scamming the medical system and having information technology that is outdated.

“They each tried to use the Medicare program as their own personal ATMs to steal precious health-care dollars,” commented U.S. Attorney Wifredo Ferrer at the press conference.

In regards to outdated technology, the Chicago Tribune reports that Sebelius hopes to soothe fears with a new data system that will better aid authorities in tracking billing patterns more efficiently.