Government Seeks to Recover $30 Million In Medicare Fraud

MIAMI – R. Alexander Acosta, United States Attorney for the Southern District of Florida, Daniel R. Levinson, Inspector General, Department of Health and Human Services, Melody Jackson, Special Agent in Charge, Office of Investigations, Office of the Inspector General, U.S. Department of Health and Human Services (HHS OIG), and Jonathan I. Solomon, Special Agent in Charge, Federal Bureau of Investigation, Miami Field Division (FBI), announce the results of Operation Equity Excise. Thus far, Operation Equity Excise has recovered approximately $10.5 million dollars in fraudulently obtained Medicare funds. Through the filing of civil False Claims Act complaints against 23 clinics and durable medical equipment (DME) companies, the U.S. Attorney’s Office seeks an additional $30 million.

Fighting Medicare fraud is an ongoing priority of the United States Attorney’s Office for the South District of Florida. As part of this anti-fraud effort, the U.S. Attorney’s Office, the Department of Health and Human Services, and the FBI launched Operation Equity Excise. This operation has identified clinics and DME companies that engaged in health care fraud. In an effort to avoid detection from law enforcement, these companies often closed abruptly, abandoning bank accounts. Some of these bank accounts contained high balances. Further investigation by HHS and the FBI established that many of these accounts were set up by “nominee” owners of clinics or durable medical equipment companies that were engaged in Medicare fraud.

During Phase I of the operation, federal agents attempted to locate the signatory on the bank accounts or the officers or registered agents of the clinics or durable medical equipment companies. Many of the signatories on the accounts, who were also typically listed in incorporation papers as the president of the company, denied knowledge of the operation of the company and denied having any claim or right to the funds in the accounts. Many of them voluntarily returned the funds in the bank accounts to the Medicare Program. During Phase I, approximately $10.5 million was voluntarily returned to the government through 34 different individuals.

In other instances, federal agents could not locate anyone who admitted having any responsibility for the accounts or the operation of the clinic or durable medical equipment company. During Phase II of the project, federal agents focused the investigation on these particular companies.

As a result of Phase II, 23 complaints were filed today against 23 clinics and DMEs, in which the government alleges Medicare fraud.

In one case, for example, the clinic billed more than 3,757 claims to Medicare, totaling more than $7.38 million between February 2006 and July 2006. The clinic listed a single physician as the prescribing physician on 2,923 of those claims. The investigation revealed that this physician was never affiliated with the clinic, had never heard of the corporation, and had never rendered the services for which the clinic had submitted the 2,923 Medicare claims. These fraudulent claims resulted in the payment of more than $1.6 million of Medicare funds to the clinic.

Acosta stated, “Operation Equity Excise has already recovered more than $10 million in fraudulently paid healthcare claims. Through the 23 lawsuits filed today, we hope to recover an additional $30 million to help replenish the scarce resources of the Medicare system. We will aggressively pursue both civil and criminal sanctions to help reduce the millions wasted each year on fraudulent healthcare claims.”

“These results demonstrate the benefits of effective collaboration between HHS OIG and our law enforcement partners to root out fraud and recover Medicare funds from suspect providers,” said Levinson. “This initiative is one example of HHS OIG’s ongoing efforts to identify and hold accountable providers who exploit vulnerabilities in the Medicare program.”

Agent Solomon added, “The amount of taxpayer money that is stolen by criminals abusing the Medicare reimbursement system is substantial, particularly in South Florida.  However, with the success of Operation Equity Excise, we hope to continue recovering stolen funds. The FBI has devoted significant resources to address health care fraud and it will continue to be a top priority for the Miami FBI office.”

Acosta commended the investigative efforts of the Department of Health and Human Services, the Federal Bureau of Investigation, and the Fraud Section of the Civil Division of the Department of Justice.  These cases are being litigated by Special Assistant U.S. Attorneys Mark Wachlin, Arianne Callender, Maame Gyamfi, Joseph Hudzick and Tony Maida, and by Assistant United States Attorneys Mark Lavine, Ann St. Peter-Griffith and Jeffrey Dickstein.

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A copy of this press release may be found on the website of the United States Attorney’s Office for the Southern District of Florida at www.usdoj.gov/usao/fls. Related court documents and information may be found on the website of the District Court for the Southern District of Florida at www.flsd.uscourts.gov or on http://pacer.flsd.uscourts.gov.

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