Pharmacy Owners Charged in Massive Medicare Fraud Takedown

Allegations include conspiracy to commit health care fraud, violations of the anti-kickback statutes, money laundering, and aggravated identity theft.

Nearly 250 individuals, including pharmacy owners and physicians, have been charged for allegedly participating in various Medicare fraud schemes following a nationwide sweep.

Accused of submitting Medicare and Medicaid claims for medically unnecessary treatments that were often never provided, the defendants have been charged with crimes such as conspiracy to commit health care fraud, violations of the anti-kickback statutes, money laundering, and aggravated identity theft. Altogether, the 243 defendants allegedly conspired to submit a total of approximately $712 million in fraudulent billing.

Pharmacy fraud was among the more common schemes, with at least 44 of the defendants charged with fraud related to Medicare Part D. In Detroit, several defendants face charges after allegedly filing claims for medicine that was billed but not dispensed, while 3 owners of a hospice service have been accused of receiving kickbacks for referrals made by 2 doctors who prescribed unnecessary medication.

Additionally, 73 defendants in Miami were charged for participating in various home health care, mental health services, and pharmacy fraud schemes, which totaled $263 million in false billings.

“The defendants charged include doctors, patient recruiters, home health care providers, pharmacy owners, and others. They billed for equipment that wasn’t provided, for care that wasn’t needed, and for services that weren’t rendered,” said Attorney General Loretta E. Lynch in a press release. “In the days ahead, the Department of Justice will continue our focus on preventing wrongdoing and prosecuting those whose criminal activity drives up medical costs and jeopardizes a system that our citizens trust with their lives.”

FBI Director James B. Comey added that “the people charged in this case targeted the system each of us depends on in our most vulnerable moments."

“Health care fraud is a crime that hurts all of us, and each dollar taken from programs that help the sick and the suffering is one dollar too many,” Comey stated.

This coordinated takedown is the largest operation the Medicare Fraud Strike Force has initiated since its inception in 2007, in terms of the number of defendants charged and alleged loss amount.

“This administration is committed to fighting fraud and protecting taxpayer dollars in Medicare and Medicaid,” stated Department of Health and Human Services Secretary Sylvia M. Burwell. “This takedown adds to the hundreds of millions we have saved through fraud prevention since the Affordable Care Act was passed.”

The defendants charged will be investigated and prosecuted by Strike Force teams from the Fraud Section of the Justice Department’s Criminal Division and the US Attorney's Offices for the defendants' respective districts. All those charged are presumed innocent until proven guilty.