National Health Care Fraud Takedown Results in Charges Against 590 Individuals Responsible for $2 Plus Billion in Fraud Losses

By   /  July 12, 2018  /  Comments Off on National Health Care Fraud Takedown Results in Charges Against 590 Individuals Responsible for $2 Plus Billion in Fraud Losses

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Source: Federal Bureau of Investigation (FBI) State Crime News

Largest Health Care Fraud Enforcement Action in Department of Justice History Resulted in 150+ Doctors Charged and 80 Opioid Cases Involving More Than 13 Million Illegal Dosages of Opioids

Roanoke, VIRGINIA – Attorney General Jeff Sessions and Department of Health and Human Services (HHS) Secretary Alex M. Azar III, announced yesterday the largest ever health care fraud enforcement action by the Medicare Fraud Strike Force, involving 590+ charged defendants across 56 federal districts, including 150+ doctors, nurses and other licensed medical professionals, for their alleged participation in health care fraud schemes involving approximately $2 billion in false billings. Of those charged, over 150 defendants, including doctors, were charged for their roles in prescribing and distributing opioids and other dangerous narcotics. Twenty-nine state Medicaid Fraud Control Units also participated in today’s arrests. 

Yesterday’s enforcement actions were led and coordinated by the Criminal Division, Fraud Section’s Health Care Fraud Unit in conjunction with its Medicare Fraud Strike Force (MFSF) partners, a partnership between the Criminal Division, U.S. Attorney’s Offices, the FBI and HHS-OIG.  In addition, the operation includes the participation of the DEA, DCIS, IRS-CI, Department of Labor, other various federal law enforcement agencies, and State Medicaid Fraud Control Units. 

According to court documents, the defendants allegedly participated in schemes to submit claims to Medicare, Medicaid, TRICARE, and private insurance companies for treatments that were medically unnecessary and often never provided. In many cases, patient recruiters, beneficiaries and other co-conspirators were allegedly paid cash kickbacks in return for supplying beneficiary information to providers, so that the providers could then submit fraudulent bills to Medicare for services that were medically unnecessary or never performed. Collectively, the doctors, nurses, licensed medical professionals, health care company owners and others charged are accused of submitting a total of over $2 billion in fraudulent billings.  The number of medical professionals charged is particularly significant, because virtually every health care fraud scheme requires a corrupt medical professional to be involved in order for Medicare or Medicaid to pay the fraudulent claims.  Aggressively pursuing corrupt medical professionals not only has a deterrent effect on other medical professionals, but also ensures that their licenses can no longer be used to bilk the system.

In the Western District of Virginia, two indictments returned this week were included in the nationwide takedown. In both cases, the United States Attorney’s Office collaborated with the Department of Health and Human Services-Office of the Inspector General and the Virginia Office of the Attorney General’s Medicaid Fraud Control Unit.

In a 73-count indictment returned earlier this week and announced yesterday, East Mental Health, LLC, Christopher Dean East, Joann Kathleen Patterson, Alfred Lloyd Robrecht, William Barclay Allison and Ryan Thomas Greene were charged with conspiracy to commit health care fraud, and other related charges.

According to the indictment, the defendants operated East Mental Health, also known as East Wellness Center, located in Roanoke. The defendants allegedly conspired to fraudulently obtain $45 million from Medicaid over a ten-year period by falsifying mental health progress notes and billing Medicaid based on those false notes for services that were not rendered as described and allowed. East Mental Health, a facility that provided support to individuals with mental illnesses, abruptly closed their facility in October 2017 after becoming the target of a federal whistleblower lawsuit that was filed in 2013.

In a separate 17-count indictment returned this week, Vickie Phanelson Adams and Latoya Litchel Preston were charged with health care fraud. According to the indictment, Adams owned and operated MPowering Kids, a therapeutic day treatment center for children and adolescents and Golden Touch Home Health Care, a home based personal care service facilitation company assisting elderly and disabled adults. The indictment alleges that Adams and Preston falsified multiple Weekly Progress Notes for mental health services that were never provided and Adams falsified Golden Touch Home Assessments notes for services which were never provided.

A complaint, information, or indictment is merely an allegation, and all defendants are presumed innocent until proven guilty beyond a reasonable doubt in a court of law.

MIL Security OSI

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