Medicare Fraud Strike Force Charges 111 Individuals for More Than $225 Million in Fal


Department of Justice Office of Public Affairs


Thursday, February 17, 2011

Medicare Fraud Strike Force Charges 111 Individuals for More Than $225 Million in False Billing and Expands Operations to Two Additional Cities

Doctors, Nurses, Health Care Company Owners and Executives Among the Defendants Charged; Law Enforcement Agents Execute 16 Search Warrants

WASHINGTON - The Medicare Fraud Strike Force today charged 111 defendants in nine cities, including doctors, nurses, health care company owners and executives, and others, for their alleged participation in Medicare fraud schemes involving more than $225 million in false billing, announced Attorney General Eric Holder, Health and Human Services (HHS) Secretary Kathleen Sebelius, FBI Executive Assistant Director Shawn Henry, Assistant Attorney General Lanny A. Breuer of the Criminal Division and HHS Inspector General Daniel Levinson. Also today, the Department of Justice (DOJ) and HHS announced the expansion of Medicare Fraud Strike Force operations to two additional cities - Dallas and Chicago. Today's operation is the largest-ever federal health care fraud takedown.

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Home Health Columnist / Guide


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“Over the last two years our joint efforts have more than quadrupled the number of anti-fraud Strike Force teams operating in fraud hot spots around the country from two to nine -- with the latest additions Chicago and Dallas -- bringing hundreds of charges against criminals who had billed Medicare for hundreds of millions of dollars. Last year alone, our partnership recovered a record $4 billion on behalf of taxpayers. From 2008-2010, every dollar the Federal Government spent under its Health Care Fraud and Abuse Control programs averaged a return on investment of $6.80,” said HHS Secretary Sebelius.

The defendants charged today are accused of various health care fraud-related crimes, including conspiracy to defraud the Medicare program, criminal false claims, violations of the anti-kickback statutes, money laundering and aggravated identity theft. The charges are based on a variety of alleged fraud schemes involving various medical treatments and services such as home health care, physical and occupational therapy, nerve conduction tests and durable medical equipment.

The Medicare Fraud Strike Force was beefed up directly as a result of the passage of that pesky Affordable Care Act, aka Obama Care-- another good thing resulting from this legislation.

New Resources to Fight Fraud: The Affordable Care Act provides an additional $350 million over the next ten years to help fight fraud through the Health Care Fraud and Abuse Control Account (HCFAC) from FY 2011 through 2020. The Act also allows these funds to support the hiring of new officials and agents that can help prevent and identify fraud.

The Affordable Care Act: New Tools to Fight Fraud, Strengthen Medicare and Protect Taxpayer Dollars

Home Health Columnist / Guide


11 Articles; 17,838 Posts

Specializes in Vents, Telemetry, Home Care, Home infusion. Has 46 years experience.

Dallas Doctor Arrested for Alleged Role in Nearly $375 Million Home Health Care Fraud Scheme

Office Manager for Doctor and Five Owners of Dallas-Area Home Health Agencies Also Arrested

Average physician signs maximum ~ 100 or fewer Home Health Plan of Care Certifications/year in agency where I manage Central Intake while this doctor signed off 5,000!!! Karen

According to the indictment, Dr. Roy owned and operated Medistat Group Associates P.A. in the Dallas area. Medistat was an association of health care providers that primarily provided home health certifications and performed patient home visits. Dr. Roy allegedly certified or directed the certification of more than 11,000 individual patients from more than 500 HHAs for home health services during the past five years. Between January 2006 and November 2011, Medistat certified more Medicare beneficiaries for home health services and had more purported patients than any other medical practice in the United States. These certifications allegedly resulted in more than $350 million being fraudulently billed to Medicare and more than $24 million being fraudulently billed to Medicaid by Medistat and HHAs. ...

“Using sophisticated data analysis we can now target suspicious billing spikes,” said HHS Inspector General Levinson. “In this case, our analysts discovered that in 2010, while 99 percent of physicians who certified patients for home health signed off on 104 or fewer people – Dr. Roy certified more than 5,000.”

tyvin, BSN, RN

1,620 Posts

Specializes in Hospice / Psych / RNAC.

The strike force was formed and started in March of 2007. The cases that are being talked about in the 1 year old article (in your first post) had their inception long before the ACA put that little bit of money their way (it really is a small amount to last for the next 10 years). There's no need to defend the's law already.

Dr.Roy; they were watching him hang himself for a long time. These types of cases take years to set up and execute. That doctor's hand has got to be tired.

Each administration builds off the's the American way.

allnurses Guide

herring_RN, ASN, BSN

3,651 Posts

Specializes in Critical care, tele, Medical-Surgical. Has 51 years experience.

Most recent settlements and convictions.

Stopping these criminals saves medicare millions every year.

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