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HHS Report to Congress on Progress of
Anti-Fraud Efforts
Report to Congress Fraud Prevention System, Second Implementation Year, June 2014.
The Centers for Medicare & Medicaid Services strives to make information accessible to all. Nevertheless, portions of this report may be difficult to read using assistive technology. People with disabilities having problems accessing this report may send an email to 508_Compliance@cms.hhs.gov.
Medicare Fraud Strike Force charges 90 individuals for approximately $260 million in false billing
Attorney General Eric Holder and Department of Health and Human Services (HHS) Secretary Kathleen Sebelius announced today that a nationwide takedown by Medicare Fraud Strike Force operations in six cities has resulted in charges against 90 individuals, including 27 doctors, nurses and other medical professionals, for their alleged participation in Medicare fraud schemes involving approximately $260 million in false billings.
Record-Breaking Recoveries Resulting From Joint HHS/DOJ Effort to Combat Health Care Fraud
Annual report shows that for every dollar spent on health care-related fraud and abuse investigations in the last three years, the government recovered $8.10.
Medicare Fraud strike force charges 89 individuals for approximately $223 million in false billing
Attorney General Eric Holder and HHS Secretary Kathleen Sebelius announce a nationwide takedown by Medicare Fraud Strike Force operations in eight cities.
HHS would increase rewards for reporting fraud to nearly $10 million
Health and Human Services Secretary Kathleen Sebelius today announced a proposed rule that would increase rewards paid to Medicare beneficiaries and others whose tips about suspected fraud lead to the successful recovery of funds to as high as $9.9 million.
Enforcement News
December 8, 2014
New Jersey - OtisMed Corporation and Former CEO Plead Guilty to Distributing FDA-Rejected Cutting Guides for Knee Replacement Surgeries
Newark, New Jersey - OtisMed Corp. and its former chief executive officer (CEO) admitted today to intentionally distributing knee replacement surgery cutting guides after their application for marketing clearance had been rejected by the Food and Drug Administration (FDA), and the corporation agreed to pay more than $80 million to resolve its related criminal and civil liability, the Justice Department announced today.
December 8, 2014
Florida - Miami-Area Certified Nursing Assistant Sentenced to 150 Months in Prison for Role in $200 Million Medicare Fraud Scheme
Miami, Florida - A Miami licensed nursing assistant was sentenced today to serve 150 months in prison for participating in a $200 million Medicare fraud scheme involving fraudulent billings by American Therapeutic Corporation (ATC), a mental health company headquartered in Miami.
December 3, 2014
New York - Ten Defendants Charged In $70 Million Scheme To Defraud Medicaid And Medicare Through Medical Clinics In Brooklyn And Queens
Brooklyn and Queens, New York - Preet Bharara, the United States Attorney for the Southern District of New York, George Venizelos, the Assistant Director-in-Charge of the New York Office of the Federal Bureau of Investigation ("FBI"), William J. Bratton, Commissioner of the New York City Police Department ("NYPD), and Thomas O'Donnell, the Special Agent-in-Charge of the New York Office of the Department of Health and Human Services, announced today the unsealing of an indictment charging ten defendants with operating a massive health care fraud scheme through three medical clinics in Brooklyn and Queens through which the defendants submitted over $70 million in fraudulent claims to Medicaid and Medicare.
December 3, 2014
Massachusetts - Owner of Nursing Agency Convicted of Multi-Million Dollar Fraud and Money Laundering Scheme
Boston, Massachusetts - After deliberating for less than four hours, a federal jury convicted the owner of a home nursing agency for fraudulently billing millions of dollars of services to Medicare and then laundering the proceeds. The jury also decided that the defendant's $750,000 home in Natick is forfeitable because it was purchased with the fraud proceeds.
December 2, 2014
Florida - Principal in $28.3 Million Medicare Fraud Scheme Sentenced to 11 Years in Prison
Tampa, Florida - A Florida owner and operator of multiple physical therapy rehabilitation facilities was sentenced in federal court in Tampa today to serve 11 years in prison for his role in organizing a $28.3 million Medicare fraud scheme involving physical and occupational therapy services.
November 19, 2014
Florida - Eleven Individuals Charged for Their Role in Medicare and Medicaid Fraud Scheme Executed in Florida, Nicaragua, and the Dominican Republic
Miami, Florida - Eight residents of Miami-Dade County and three residents of Nicaragua have been charged for their alleged participation in a $25.2 million Medicare, Medicaid, and wire fraud scheme.
November 18, 2014
Florida - Miami-Area Hospital Chief Operating Officer Pleads Guilty in $67 Million Mental Health Care Fraud Scheme
Miami, Florida - The former chief operating officer of a Miami-area hospital pleaded guilty today for his role in a mental health care fraud scheme that resulted in the submission of more than $67 million in fraudulent claims to Medicare by a state-licensed psychiatric hospital located in Hollywood, Florida, that purported to offer both inpatient and outpatient mental health services.
November 17, 2014
New Jersey - Doctor Admits Taking Bribes in Test-Referral Scheme with New Jersey Clinical Lab
Newark, New Jersey - A doctor with practices in Wall Township and Howell Township, New Jersey, today admitted accepting bribes in exchange for test referrals as part of a long-running scheme operated by Biodiagnostic Laboratory Services LLC (BLS), of Parsippany, New Jersey, its president and numerous associates, U.S. Attorney Paul J. Fishman announced.
November 14, 2014
Michigan - Michigan Physician Pleads Guilty for Role in $19 Million Medicare Fraud Scheme
Detroit, Michigan - A Detroit-area physician, who orchestrated the submission of fraudulent claims for physician home visits and directed fraudulent referrals for home health care by his employee physicians as part of a $19 million home health care fraud scheme, pleaded guilty today for his role in the conspiracy.
November 13, 2014
Florida - Owner of Miami Home Health Company Pleads Guilty for Role in $30 Million Health Care Fraud Scheme
Miami, Florida - An owner of a Miami home health care company pleaded guilty today for his role in a $30 million home health Medicare fraud scheme.
November 12, 2014
Tennessee - Careall Companies Agree to Pay $25 Million to Settle False Claims Act Allegations
Nashville, Tennessee - CareAll Management LLC and its affiliated entities (collectively “CareAll”) have agreed to pay $25 million, plus interest, to the United States and the state of Tennessee to resolve allegations that CareAll violated the False Claims Act by submitting false and upcoded home healthcare billings to the Medicare and Medicaid programs, the Department of Justice announced today. CareAll is based in Nashville, Tennessee, and is one of Tennessee’s largest home health providers.
November 6, 2014
New York - Manhattan U.S. Attorney Settles Civil Fraud Claims Against Visiting Nurse Service For Obtaining Millions In Medicaid Payments By Enrolling Ineligible Individuals In Its Managed Long-Term Care Plans And For Providing Substandard Services At Social Adult Day Care Centers
Manhattan, New York - VNS Admits and Acknowledges that 1,740 Managed Long-Term Care Plan Members Were Ineligible and Agrees to Pay Nearly $35 Million.
November 5, 2014
Florida - Owner and Administrator of Two Miami Home Health Companies Sentenced to 80 Months in Prison for $74 Million Fraud Scheme
Miami, Florida - The owner and administrator of two Miami home health care companies was sentenced today to serve 80 months in prison for her participation in a $74 million Medicare fraud scheme.
October 31, 2014
Louisiana - Owner and Patient Recruiter Sentenced to Prison for Their Roles in $258.5 Million Medicare Fraud Scheme
Baton Rouge, Louisiana - An owner and operator of two community mental health centers in Baton Rouge, Louisiana, and a patient recruiter for a community mental health center in Houston, Texas, were sentenced to prison today for their involvement in a $258.5 million Medicare fraud scheme involving partial hospitalization psychiatric (PHP) services.
October 30, 2014
California - Dignity Health Agrees to Pay $37 Million to Settle False Claims Act Allegations
San Francisco, California - Dignity Health has agreed to pay the United States $37 million to settle allegations that 13 of its hospitals in California, Nevada and Arizona knowingly submitted false claims to Medicare and TRICARE by admitting patients who could have been treated on a less costly, outpatient basis, the Justice Department announced today. Dignity, formerly known as Catholic Healthcare West, is based in San Francisco and is one of the five largest hospital systems in the nation with 39 hospitals in three states.
October 29, 2014
Michigan - Detroit-Area Home Health Care Assistant Sentenced for Scheme to Bill Medicare Nearly $15 Million for Services Never Provided
Detroit, Michigan - A physical therapist assistant was sentenced today to serve 50 months in prison for his role in a $14.9 million fraud scheme, through which he and others billed Medicare for home health services that they never provided, and provided beneficiaries with prescriptions for unnecessary painkillers and other narcotics to induce them to sign false medical documents to support the fraudulent billings.
October 22, 2014
Michigan - Founder of Detroit-Area Home Health Agencies Pleads Guilty to Health Care Fraud Conspiracy
Detroit, Michigan - The founder of three Detroit-area home health agencies pleaded guilty today in federal court for his role in a $22 million home health care fraud scheme.
October 22, 2014
Colorado - DaVita to Pay $350 Million to Resolve Allegations of Illegal Kickbacks
Denver, Colorado - DaVita Healthcare Partners, Inc., one of the leading providers of dialysis services in the United States, has agreed to pay $350 million to resolve claims that it violated the False Claims Act by paying kickbacks to induce the referral of patients to its dialysis clinics, the Justice Department announced today. DaVita is headquartered in Denver, Colorado and has dialysis clinics in 46 states and the District of Columbia.
October 21, 2014
Florida - Miami-Area Physician Assistant Sentenced to 15 Years in Prison for $200 Million Medicare Fraud Scheme
Miami, Florida - A Miami licensed physician assistant was sentenced today to serve 15 years in prison for participating in a Medicare fraud scheme involving approximately $200 million in fraudulent billings by American Therapeutic Corporation (ATC), a mental health company that was headquartered in Miami.
October 21, 2014
Maryland - Timonium Man Sentenced To 18 Months In Prison For Stealing More Than $680,000 From An NIH Research Grant
Baltimore, Maryland - Chief U.S. District Judge Catherine C. Blake sentenced Jason Dietz, age 34, of Timonium, Maryland, today to 18 months in prison, followed by three years of supervised release, for theft of funds from a federal program, in connection with the theft of $683,705 in grant money from the National Institute for Drug Abuse for research conducted at its facilities in Baltimore. Chief Judge Blake also ordered Dietz to pay restitution of $683,705.
October 20, 2014
Texas - President of Houston Hospital and Three Others Convicted in $158 Million Medicare Fraud Scheme
Houston, Texas - A federal jury in Houston today convicted the president of Riverside General Hospital (Riverside), his son, and two others for their participation in a $158 million Medicare fraud scheme involving false claims for mental health treatment. Ten defendants have now been convicted in connection with the Riverside fraud scheme.
October 10, 2014
Florida - Three Florida Residents Are Charged With Health Care Fraud, Money Laundering And Drug Trafficking
Miami, Florida - Three Miami residents have been charged in a superseding indictment with health care fraud violations stemming from a $23 million Medicare fraud scheme. Two of the defendants are also charged with drug trafficking for submitting fraudulent prescriptions for oxycodone and other drugs to pharmacies.
October 10, 2014
Deleware - Extendicare Health Services Inc. Agrees to Pay $38 Million to Settle False Claims Act Allegations Relating to the Provision of Substandard Nursing Care and Medically Unnecessary Rehabilitation Therapy
Extendicare Health Services Inc. (Extendicare) and its subsidiary Progressive Step Corporation (ProStep) have agreed to pay $38 million to the United States and eight states to resolve allegations that Extendicare billed Medicare and Medicaid for materially substandard nursing services that were so deficient that they were effectively worthless and billed Medicare for medically unreasonable and unnecessary rehabilitation therapy services, the Justice Department and the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG) jointly announced today. This resolution is the largest failure of care settlement with a chain-wide skilled nursing facility in the department's history.
October 8, 2014
Michigan - Michigan Home Health Agency Owner Pleads Guilty in $22 Million Medicare Fraud Conspiracy
Detroit, Michigan - A former owner and manager of two Detroit-area home health care agencies has pleaded guilty in federal court for his role in a $22 million Medicare fraud conspiracy.
October 2, 2014
Florida - South Florida Doctor And Other Professionals Charged With Health Care Fraud At Biscayne Milieu Health Center, Inc.
Miami, Florida - Wifredo A. Ferrer, United States Attorney for the Southern District of Florida, George L. Piro, Special Agent in Charge, Federal Bureau of Investigation (FBI), Miami Field Office, and Derrick Jackson, Acting Special Agent in Charge, U.S. Department of Health and Human Services, Office of Inspector General's (HHS-OIG), Miami Regional Office, announce that Salo Shapiro, 69, a medical doctor, of Broward County, Marlene Cesar, 63, a licensed nurse practitioner, of Allentown, Pennsylvania and former resident of Miami, and Sonia Gallimore, 73, a licensed mental health counselor, of Broward County, were indicted on charges of conspiracy to commit health care fraud, health care fraud, and false statements related to health care matters, in violation of Title 18, United States Code, Sections 1349, 1347, and 1035.
October 1, 2014
Michigan - Detroit-Area Operator of Adult Day Care Center, Two Home Health Care Company Owners Convicted in $29 Million Medicare Fraud Conspiracy
Detroit, Michigan - A federal jury in Detroit late yesterday convicted the operator of an adult day care center and two individuals who owned and operated a network of home health care companies for their participation in a $29 million Medicare fraud scheme.
September 26, 2014
Texas - Former Owner of Durable Medical Equipment Company Arrested in Health Care Fraud and Money Laundering Scheme
Houston, Texas - A Miami man was arrested today on health care fraud and money laundering charges in connection with an alleged $24 million scheme to defraud Medicare
September 25, 2014
Louisiana - Seven Defendants Indicted and Three Other Defendants Plead Guilty for Their Roles in $56 Million Medicare Fraud Scheme
New Orleans, Louisiana - A New Orleans grand jury today indicted seven defendants for their roles in a $56 million Medicare fraud scheme that operated in New Orleans and surrounding communities. Thirteen defendants have now been charged in this case, three of whom pleaded guilty to their conduct yesterday.
September 24, 2024
Pennsylvania - Shire Pharmaceuticals LLC to Pay $56.5 Million to Resolve False Claims Act Allegations Relating to Drug Marketing and Promotion Practices
Wayne, Pennsylvania - Pharmaceutical company Shire Pharmaceuticals LLC will pay $56.5 million to resolve civil allegations that it violated the False Claims Act as a result of its marketing and promotion of several drugs, the Justice Department announced today. Shire, located in Wayne, Pennsylvania, manufactures and sells pharmaceuticals, including Adderall XR, Vyvanse and Daytrana, which are approved for the treatment of attention deficit hyperactivity disorder (ADHD), and Pentasa and Lialda, which are approved for the treatment of mild to moderate active ulcerative colitis.
September 15, 2014
Maryland - Owner Of Alpha Diagnostics Indicted For $7.5 Million Health Care Fraud Scheme
Baltimore, Maryland - A federal grand jury has indicted the owner of Alpha Diagnostics, Rafael Chikvashvili, age 67, of Baltimore, Maryland, on health care fraud and other charges related to a scheme to defraud Medicare and Medicaid of more than $7.5 million. The indictment was returned on September 11, 2014, and unsealed today. Chikvashvili had an initial appearance today in U.S. District Court in Baltimore and was released under the supervision of U.S. Pretrial Services.
August 8, 2014
California - McKesson Corp. to Pay $18 Million to Resolve False Claims Allegations Related to Shipping Services Provided Under Centers for Disease Control Vaccine Distribution Contract
McKesson Corporation has agreed to pay $18 million to resolve allegations that it improperly set temperature monitors used in shipping vaccines under its contract with the Centers for Disease Control and Prevention, the Justice Department announced today. McKesson is a pharmaceutical distributor with corporate headquarters in San Francisco.
August 4, 2014
Tennessee - Community Health Systems Inc. to pay $98.15 Million to Resolve False Claims Act Allegations
The Justice Department announced today that Community Health Systems Inc. (CHS), the nation's largest operator of acute care hospitals, has agreed to pay $98.15 million to resolve multiple lawsuits alleging that the company knowingly billed government health care programs for inpatient services that should have been billed as outpatient or observation services. The settlement also resolves allegations that one of the company's affiliated hospitals, Laredo Medical Center, improperly billed the Medicare program for certain inpatient procedures and for services rendered to patients referred in violation of the Physician Self-Referral Law, commonly known as the Stark Law. CHS is based in Franklin, Tennessee, and has 206 affiliated hospitals in 29 states.
Captured
August 8, 2014
Texas – Pablo Piedra Perez was arrested in Texas after reentering the United States from Mexico
On April 11, 2014, Pablo Piedra Perez was sentenced to 2 years and 7 months in jail and ordered to pay $679,715 in restitution after pleading guilty to a charge of health care fraud. Perez was arrested in September 2013 in Texas after reentering the United States from Mexico.
June 3, 2014
Texas - Vivian Yusuf was arrested at Houston International Airport after arriving on a flight from Nigeria.
In March 2011, Yusuf was indicted on charges of conspiracy to commit health care fraud, health care fraud, and aggravated identity theft. Investigators believe that Yusuf and her co-conspirators billed Medicare for more than $3.4 million for durable medical equipment (DME) that was neither medically necessary nor prescribed by a physician.
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