AG LYNCH'S REMARKS ON $712 MEDICARE FRAUD

FROM:  U.S JUSTICE DEPARTMENT
Attorney General Loretta Lynch Delivers Remarks at the Press Conference to Announce a National Medicare Fraud Takedown
Washington, DCUnited States ~ Thursday, June 18, 2015
Remarks as prepared for delivery

Good morning. Before we begin today’s announcement, I want to take a moment to address the heartbreaking and deeply tragic events at Emanuel AME Church in Charleston, South Carolina – a crime that has reached into the heart of that community.  The Department of Justice has opened a hate crime investigation into this shooting incident.  The FBI, ATF, U.S. Marshals Service, Civil Rights Division and U.S. Attorney’s Office are working closely with our state and local partners, and we stand ready to offer every resource, every means and every tool that we possess in order to locate and apprehend the perpetrator of this barbaric crime.  Acts like this one have no place in our country.  They have no place in a civilized society.  And I want to be clear: the individual who committed these unspeakable acts will be found and will face justice.

As we move forward, my thoughts and prayers – and those of our entire law enforcement community, here at the Department of Justice and around the country – are with the families and loved ones of the victims in Charleston.  Even as we struggle to comprehend this heartbreaking event, I want everyone in Charleston – and everyone who has been affected by this tragedy – to know that we will do everything in our power to help heal this community and make it whole again.

I encourage the people of Charleston and the wider area to continue circulating the photos of the alleged perpetrator and report any tip, no matter how minor, to the tip line, which can be reached at 1-800-CALL-FBI.

Today, I’m joined by Secretary [Sylvia] Burwell from the Department of Health and Human Services; Director [Jim] Comey of the FBI; Assistant Attorney General [Leslie] Caldwell of the Justice Department’s Criminal Division; Inspector General [Daniel] Levinson of the HHS Office of Inspector General; and Deputy Administrator and Director Dr. [Shantanu] Agrawal of the Centers for Medicare and Medicaid Services in announcing a major advance in the federal government’s fight against fraud in our nation’s health care system.

Over the last three days, as part of a coordinated, nationwide takedown, the Medicare Fraud Strike Force – a joint initiative of the Departments of Justice and Health and Human Services comprising federal, state and local investigators and law enforcement officials from across the country – joined seven additional U.S. Attorney’s Offices in charging or unveiling charges against 243 defendants in 17 federal districts for their alleged participation in Medicare fraud schemes involving approximately $712 million. This is the largest takedown in the Strike Force’s eight-year history.  It is the largest criminal health care fraud takedown in the history of the Department of Justice.  And it adds to an already remarkable record of enforcement.

The defendants charged include doctors, patient recruiters, home health care providers, pharmacy owners, and others.  They are accused of an array of serious crimes ranging from conspiracy to commit health care fraud to wire fraud to money laundering.  They billed for equipment that wasn’t provided, for care that wasn’t needed, and for services that weren’t rendered.  In one of the more egregious allegations of exploitation of both the Medicare system and vulnerable patients, the owners of a mental health facility in Miami billed for intensive psychotherapy sessions that resulted in tens of millions in reimbursements for the doctors based on treatment that was nothing more than moving patients to different locations.  Several of these patients suffered from illnesses like Alzheimer’s and dementia and were unable even to communicate with their supposed caregivers.

Further, nearly 50 of the defendants in this takedown are charged with fraud related to the Medicare prescription drug benefit program known as Part D, which is the fastest-growing component of the Medicare program overall.  One owner of a health care provider in the Southern District of Florida received $1.6 million from Medicare Part D for prescription drugs the provider never purchased and never dispensed.  Another defendant – a doctor in the Eastern District of Michigan – is alleged to have prescribed unnecessary narcotic pain medications to patients in exchange for the use of their identification information to generate false billings.  Patients who attempted to withdraw from the scheme were threatened with loss of access to prescription narcotics.  Having deepened these patients’ addiction, the doctors then used that addiction to keep patients bound to their scheme.  Taken in total, today’s action represents the first large-scale effort to focus on Medicare Part D fraud – and demonstrates an expanded federal focus on this important issue.

The charges we are announcing today are the culmination of a truly national effort, involving approximately 900 law enforcement personnel acting in concert to execute a set of highly complex and highly coordinated law enforcement activities stretching across the country from Florida to Alaska.  This takedown, like those before it, would not have been possible without the key partnerships forged by the Strike Force over the last eight years among federal, state, and local officials, and the cooperation spurred by the joint initiative known as the Health Care Fraud Prevention and Enforcement Action Team, or HEAT, that was launched by DOJ and HHS in 2009.  As a result of Strike Force operations since 2007, we’ve filed charges against more than 2,300 individuals, accounting for over $7 billion in Medicare losses.  This is a crucial part of the department’s health care fraud enforcement efforts, which include recovery of a total of $15.3 billion through False Claims Act cases involving fraud against federal health care programs since 2009.

Those are extraordinary figures, and they reflect our administration-wide commitment to safeguard precious public resources, to rid our health-care systems of fraud and abuse, and to sustain the integrity of programs that are essential to the public welfare.  In the days ahead, we 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.  The Department of Justice is prepared – and I am personally determined – to continue working with our federal, state and local partners to bring about the vital progress that all Americans deserve.

I want to thank all of the law enforcement officials who were part of the team that made this sweeping takedown possible.  Their tireless efforts enabled us to move quickly and aggressively and their inspiring collaboration will be a model for us going forward.

At this time, I’d like to turn things over to Secretary [Sylvia] Burwell, who has been a dedicated leader and indispensable partner in this important work and who will provide additional details on today’s announcement.

GUILTY PLEA GIVEN IN $5 MILLION HEALTH CARE FRAUD

FROM:  U.S. JUSTICE DEPARTMENT 

Tuesday, February 24, 2015

Former Owner of Durable Medical Equipment Company Pleads Guilty in $5 Million Health Care Fraud Scheme

A Miami man pleaded guilty today to health care fraud charges in connection with a $5 million scheme to defraud Medicare.

Assistant Attorney General Leslie R. Caldwell of the Justice Department’s Criminal Division, U.S. Attorney Wifredo A. Ferrer of the Southern District of Florida, Special Agent in Charge Derrick Jackson of the U.S. Department of Health and Human Services Office of Inspector General’s (HHS-OIG) Miami Field Office, Special Agent in Charge Mike Fields of HHS-OIG’s Dallas Field Office, Special Agent in Charge Paul Wysopal of the FBI’s Tampa Field Office, and Special Agent in Charge Perrye K. Turner of the FBI’s Houston Field Office made the announcement.

Angel M. Mirabal, 62, of Miami, Florida, pleaded guilty to one count of conspiracy to commit wire fraud and health care fraud before U.S. District Judge Marcia G. Cooke of the Southern District of Florida.  A sentencing hearing is scheduled for May 6, 2015.

In connection with his guilty plea, Mirabal admitted that he was the owner, president and manager of Quick Solutions Medical Supplies Inc. (Quick Solutions), a durable medical equipment (DME) supply company located in Houston, Texas.  Mirabel further admitted that from April 2010 through July 2013, he and his co-conspirators operated Quick Solutions for the purpose of billing the Medicare program for, among other things, expensive DME that was medically unnecessary and in many instances not provided to the Medicare beneficiaries.  Indeed, many of the beneficiaries who purportedly received the DME resided hundreds of miles away in Miami.

From June 2011 through February 2012, Quick Solutions submitted approximately $5 million in fraudulent claims, and Medicare paid approximately $587,900 for these claims.

This case was investigated by the FBI, HHS-OIG and Texas Attorney General’s Medicaid Fraud Control Unit, and was brought as part of the Medicare Fraud Strike Force, under the supervision of the Criminal Division’s Fraud Section and U.S. Attorney’s Office for the Southern District of Florida.  This case is being prosecuted by Trial Attorney Timothy P. Loper of the Criminal Division’s Fraud Section.

Since its inception in March 2007, the Medicare Fraud Strike Force, now operating in nine cities across the country, has charged nearly 2,100 defendants who have collectively billed the Medicare program for more than $6.5 billion.  In addition, the HHS Centers for Medicare & Medicaid Services, working in conjunction with the HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.

HOME HEALTH CARE COMPANY OWNER PLEADS GUILTY FOR ROLE IN $74 MILLION FRAUD

FROM:  U.S. JUSTICE DEPARTMENT  

Wednesday, July 23, 2014

Owner and Administrator of Miami Home Health Companies Pleads Guilty for Role in $74 Million Health Care Fraud Scheme

A Miami resident who owned a home health care company and was the administrator of another home health care company pleaded guilty today for her participation in a $74 million Medicare fraud scheme.

Assistant Attorney General Leslie R. Caldwell of the Justice Department’s Criminal Division, U.S. Attorney Wifredo A. Ferrer of the Southern District of Florida, Special Agent in Charge George L. Piro of the FBI’s Miami Field Office and Acting Special Agent in Charge Ryan Lynch of the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG), Office of Investigations Miami Office made the announcement.

Elsa Ruiz, 45, pleaded guilty today before U.S. District Judge Marcia G. Cooke in the Southern District of Florida to one count of conspiracy to commit health care fraud.   Her sentencing is scheduled for Oct. 8, 2014.

According to court documents, Ruiz was an owner of Professional Home Care Solutions Inc. (Professional Home Care) and an administrator of LTC Professional Consultants Inc. (LTC), Miami home health care agencies that purported to provide home health and therapy services to Medicare beneficiaries.  Ruiz and her co-conspirators operated LTC and Professional Home Care for the purpose of billing the Medicare program for, among other things, expensive physical therapy and home health care services that were not medically necessary and/or were not provided.

Also according to court documents, Ruiz ran and oversaw the schemes operating out of LTC and Professional Home Care.   Ruiz and co-conspirators paid kickbacks and bribes to patient recruiters, who provided patients to LTC and Professional Home Care , as well as prescriptions, plans of care (POCs) and certifications for medically unnecessary therapy and home health services for Medicare beneficiaries.   Ruiz and her co-conspirators used these prescriptions, POCs and medical certifications to fraudulently bill the Medicare program for unnecessary home health care and therapy services.

From approximately January 2006 to June 2012, LTC and Professional Home Care submitted approximately $74 million in claims for home health care services that were not medically necessary and/or not provided, and Medicare paid approximately $45 million on those claims.

The case was investigated by the FBI and HHS-OIG, and was brought as part of the Medicare Fraud Strike Force, supervised by the Criminal Division’s Fraud Section and the U.S. Attorney’s Office for the Southern District of Florida.   The case is being prosecuted by Assistant Chief Joseph S. Beemsterboer of the Criminal Division’s Fraud Section.

Since its inception in March 2007, the Medicare Fraud Strike Force, now operating in nine cities across the country, has charged nearly 1,900 defendants who have collectively billed the Medicare program for more than $6 billion.  In addition, the HHS Centers for Medicare and Medicaid Services, working in conjunction with the HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.

OWNERS OF HEALTH CARE COMPANY SENTENCED FOR ROLES IN $17.1 MILLION FRAUD

FROM:  U.S. JUSTICE DEPARTMENT 

Thursday, August 15, 2013
Operators of Louisiana Home Health Company Sentenced for $17.1 Million Health Care Fraud Scheme

The owner of South Louisiana Home Health Care Inc. and the director of nursing for the Louisiana home health agency were sentenced today for their roles in a Medicare fraud scheme involving the payment of kickbacks and the falsification of documents.

Acting Assistant Attorney General Mythili Raman of the Criminal Division; Acting U.S. Attorney Walt Green of the Middle District of Louisiana; Special Agent in Charge Mike Fields of the Dallas Region of the HHS Office of the Inspector General (HHS-OIG); Special Agent in Charge Michael Anderson of the FBI’s New Orleans Division; and Louisiana State Attorney General James Buddy Caldwell made the announcement.

Louis T. Age Jr., 64, owned and operated South Louisiana Home Health Care and operated this company along with his former wife, Verna Age, 60, who served as the company’s director of nursing. Louis Age and Verna Age, both of Slidell, La., were sentenced today by U.S. District Judge James J. Brady of the Middle District of Louisiana to 180 months and 60 months in prison, respectively, and ordered to forfeit $9.2 million and pay $17.1 in restitution.

After a jury trial in March 2013, Louis Age and Verna Age each were convicted of one count of conspiracy to commit health care fraud, and Louis Age also was convicted of one count of conspiracy to defraud the United States and to pay or receive illegal health care kickbacks.  Verna Age previously was convicted of one count of conspiracy to defraud the United States and to pay or receive illegal health care kickbacks after a jury trial in October 2012.

According to evidence presented at trial, Louis Age and Verna Age paid kickbacks to patient recruiters to obtain Medicare beneficiary information.  Nurses, including registered nurse Verna Age, then falsified qualification documents to make it appear that these beneficiaries qualified for home health services.  The evidence also showed that Louis Age hired and paid kickbacks to medical doctors to sign fraudulent referrals and certifications for home health services that were not medically necessary.  Louis Age and Verna Age then used the Medicare beneficiary information and false documents to bill Medicare for the medically unnecessary home health services.  From 2005 through 2011, Medicare paid South Louisiana Home Health Care approximately $17.1 million based on these fraudulent home health care claims.
 
This case was investigated by the FBI, HHS-OIG and Medicaid Fraud Control Unit of the Louisiana State Attorney General’s Office and was brought as part of the Medicare Fraud Strike Force, under supervision of the Criminal Division’s Fraud Section and the U.S. Attorney’s Office for the Middle District of Louisiana. The case was prosecuted by Trial Attorneys David M. Maria and Abigail B. Taylor of the Fraud Section, with assistance from Trial Attorney Arunabha Bhoumik.

Since its inception in March 2007, the Medicare Fraud Strike Force, now operating in nine cities across the country, has charged more than 1,500 defendants who have collectively billed the Medicare program for more than $5 billion.  In addition, HHS’s Centers for Medicare & Medicaid Services, working in conjunction with HHS-OIG, is taking steps to increase accountability and decrease the presence of fraudulent providers.

U.S. JUSTICE DEPARTMENT REPORTS RECOVERING NEARLY $4.5 BILLION IN FALSE CLAIM ACT CASES

FROM: U.S. DEPARTMENT OF JUSTICE

Justice Department Recovers Nearly $5 Billion in False Claims Act Cases in Fiscal Year 2012

Largest Annual Recovery in Department History Department Also Sets Records for Health Care and Mortgage Fraud Recoveries And Recoveries in Whistleblower Suits

The Justice Department secured $4.9 billion in settlements and judgments in civil cases involving fraud against the government in the fiscal year ending Sept. 30, 2012, Tony West, Acting Associate Attorney General, and Stuart F. Delery, Principal Deputy Assistant Attorney General for the Civil Division, announced today. This figure constitutes a record recovery for a single year, eclipsing the previous record by more than $1.7 billion, and brings total recoveries under the False Claims Act since January 2009 to $13.3 billion – which is the largest four-year total in the Justice Department’s history and more than a third of total recoveries since the act was amended 26 years ago in 1986.

The False Claims Act is the government’s primary civil remedy to redress false claims for federal money or property, such as Medicare benefits, federal subsidies and loans and payments under contracts for goods and services, including military contracts. The 1986 amendments strengthened the act and increased incentives for whistleblowers to file lawsuits on behalf of the government, leading to more investigations and greater recoveries.

Most false claims actions are filed under the act’s whistleblower, or qui tam, provisions, which allow private citizens to file suits alleging false claims on behalf of the government. If the United States prevails in the action, the whistleblower, known as a relator, receives up to 30 perc ent of the recovery. The department saw a record 647 qui tam suits filed last fiscal year and recovered a record $3.3 billion in suits filed by whistleblowers during the same period.

The Justice Department’s 2012 efforts also included record recoveries for health care fraud, where recoveries topped $3 billion for the first time in a single fiscal year, thereby besting the previous record which had been set in fiscal year 2011. Housing and mortgage fraud accounted for an unprecedented $1.4 billion.

"Today’s announcement underscores the Obama Administration’s ongoing commitment to recover losses, to prevent fraud, to bring abuses to light, and to hold accountable those who violate the law and exploit some of the government’s most critical programs," said Attorney General Eric Holder. "Thanks to the dedicated work of attorneys, investigators, analysts, and support staff at every level of the Justice Department – along with our state and local partners across the country – we have secured the largest annual recovery in the Department's history. By aggressively investigating allegations of waste and pursuing those who would take advantage of the most vulnerable members of society, I'm confident that we will continue to build on this historic progress in the months and years ahead."

"The Justice Department, using the False Claims Act, recovered nearly $5 billion in taxpayer for false claims on the treasury, by far a record for any one year," said Acting Associate Attorney General West. "This Administration’s commitment to fighting fraud in its many forms has led to the most successful four-year period in the department’s history. Vigorous enforcement of the False Claims Act not only protects taxpayer dollars; it also protects the integrity of important government programs on which so many of us rely."

"Redressing fraud and abuse in government programs has been a top priority of the Department of Justice," Principal Deputy Assistant Attorney General Delery said. "This success is also largely attributable to the brave individuals who initiate many of the investigations through whistleblower suits and to the Obama Administration’s efforts to coordinate enforcement efforts across government. While today we focus on federal recoveries, the cases successfully pursued by the Civil Division and the United States Attorneys throughout the country also returned billions of dollars to state Medicaid funds and homeowners threatened with foreclosure. In some cases, the individuals and corporations involved were also subject to criminal sanctions and were required to enter into corporate integrity agreements to prevent future misconduct."

Health Care Fraud

As noted, this year represents the second straight year in which the department has set a new record for recoveries under the False Claims Act for health care fraud. This steady, significant and continuing success can be attributed in part to the high priority placed by the administration on fighting health care fraud. In 2009, Attorney General Holder and Health and Human Services (HHS) Secretary Kathleen Sebelius announced the creation of an interagency task force, the Health Care Fraud Prevention and Enforcement Action Team (HEAT), to increase coordination and optimize criminal and civil enforcement. This coordination has yielded historic results: From January 2009 through the end of the 2012 fiscal year, the department used the False Claims Act to recover more than $9.5 billion in federal health care dollars – also a record for any four-year period. Most of these recoveries relate to frauds against Medicare and Medicaid. For more information, go to StopMedicareFraud.gov , a web page jointly established by the Department of Justice and HHS that provides additional information on the government’s efforts in this area.

Enforcement actions involving the pharmaceutical and medical device industry were the source of some of the largest recoveries this year. The department recovered nearly $2 billion in cases alleging false claims for drugs and medical devices under federally insured health programs and, in addition, returned $745 million to state Medicaid programs. These cases include recoveries from GlaxoSmithKline LLC (GSK) and Merck, Sharp & Dohme (Merck) – two of the three top settlements this year. These recoveries do not include a $561 million False Claims Act settlement with Abbott Laboratories Inc., part of a $1.5 billion global resolution (which will be reflected in FY 2013 numbers) (details at Abbott Labs ).

GSK paid $1.5 billion to resolve False Claims Act allegations that the company (1) promoted the drugs Paxil, Wellbutrin, Advair, Lamictal and Zofran for uses not approved by the Food and Drug Administration, known as off-label use, and paid kickbacks to physicians to prescribe those drugs as well as the drugs Imitrex, Lotronex, Flovent and Valtrex; (2) made false and misleading statements concerning the safety of the drug Avandia; and (3) reported false best prices and underpaid rebates owed under the Medicaid Drug Rebate Program. The $1.5 billion in federal civil recoveries was part of a $3 billion global settlement including criminal fines and forfeitures as well as state Medicaid recoveries, making GSK the largest health care fraud settlement in U.S. history. For details, go to GSK settlement .

The department also recovered $441 million, including interest, from Merck to resolve allegations that the company promoted the drug Vioxx for off-label use for relief of rheumatoid arthritis and that company representatives made inaccurate, unsupported or misleading statements about Vioxx’s cardiovascular safety to increase sales, resulting in payments by federal health care programs. In addition, Merck paid nearly $322 million in criminal fines and returned more than $200 million to state Medicaid programs. For details, go to Merck settlement .

Adding to its successes under the False Claims Act, the Civil Division, through its Consumer Protection Branch, and together with U.S. Attorneys across the country, obtained 14 criminal convictions and $1.5 billion in criminal fines and forfeitures under the Food, Drug and Cosmetic Act (FDCA).

Mortgage and Housing Fraud

In addition to health care fraud, the department continued its aggressive pursuit of financial fraud, including fraud in the housing and mortgage industries that came to light in the wake of the financial crisis. In November 2009, President Obama established the Financial Fraud Enforcement Task Force to hold accountable the individuals and corporations who contributed to the crisis as well as those who would claim illegal advantage through false claims for funds intended to stimulate economic recovery. The task force is the broadest coalition of law enforcement, investigative, and regulatory agencies ever assembled to combat fraud. For more information on the efforts and results of the Financial Fraud Enforcement Task Force in mortgage and other financial fraud, go to StopFraud.gov .

In fiscal year 2012, the Task Force’s efforts resulted in a landmark $25 billion agreement between the federal government, the attorneys general of 49 states and the District of Columbia, on the one hand, and the nation’s five largest mortgage servicers, on the other, to address mortgage loan servicing and foreclosure abuses. The five settling companies are the Bank of America Corporation, JP Morgan Chase & Co., Wells Fargo & Company, Citigroup Inc. and Ally Financial Inc. (formerly GMAC). Among its other provisions – which included significant relief for struggling homeowners – the settlement included resolutions under the False Claims Act that returned more than $900 million to federal mortgage insurance programs, including programs designed to promote home ownership by families and veterans. In addition, the agreement provides substantial financial relief to homeowners and establishes significant new homeowner protections for the future. For details, go to $25 billion agreement .

Other significant settlements to redress false claims in connection with federally insured mortgages include a $202.3 million settlement with Deutsche Bank AG and its subsidiary MortgageIT Inc., a $158.3 million settlement with Citibank subsidiary CitiMortgage Inc. and a $132.8 million settlement with Flagstar Bank. For details, go to Deutsche Bank/MortgageIT , CitiMortgage , and Flagstar Bank .

Procurement Fraud

The department, with the assistance of other members of the Financial Fraud Enforcement Task Force, also achieved great success in the pursuit of procurement fraud, including fraud connected to the procurement of equipment and services for the military. In fiscal year 2012, the department recovered $427 million in false claims for goods and services purchased by the government, bringing total recoveries for procurement fraud since January 2009 to $1.7 billion.

The department recovered $73 million in cases related to the wars in Iraq and Afghanistan. These cases include a $37 million settlement with ATK Launch Systems Inc. to resolve allegations that ATK sold dangerous and defective illumination flares used by the Army and the Air Force for nighttime combat and for covert and search and rescue operations. In another wartime contracting case, Maersk Line Limited paid the United States $31.9 million to resolve allegations that the company knowingly overcharged the Department of Defense to transport cargo to U.S. troops in Afghanistan and Iraq. For details on these settlements, go to ATK and Maersk .

The department also recovered $200 million from software manufacturer Oracle Corp. and Oracle USA in the largest False Claims Act settlement ever obtained under a General Services Administration contract. GSA negotiates contracts with private sector companies for the purchase of commonly used commercial goods and services by agencies throughout the government. As part of their contract to gain access to the vast federal marketplace, these companies agree to disclose the discounts given to their commercial customers and to pass along those discounts to the government. The $200 million settlement with Oracle resolved allegations that the company overcharged the government by failing to disclose substantially lower prices offered to its commercial customers. For more details, go to Oracle settlement .

Recoveries in Whistleblower Suits

As part of a commemoration of the 25th anniversary of the False Claims Act amendments, the department noted earlier this year the importance of the legislation providing the tools needed to combat fraud against the government, especially by strengthening the False Claims Act’s qui tam provisions. In 1986, Senator Charles Grassley and Representative Howard Berman led successful efforts in Congress to amend the False Claims Act to, among other things, encourage whistleblowers to come forward with allegations of fraud. In 2009, Senator Patrick J. Leahy, chairman of the Senate Judiciary Committee, along with Senator Grassley and Representative Berman, championed the Fraud Enforcement and Recovery Act of 2009, which made additional improvements to the False Claims Act and other fraud statutes. And in 2010, the passage of the Affordable Care Act provided additional inducements and protections for whistleblowers and strengthened the provisions of the federal health care Anti-Kickback Statute.

The increased incentives for whistleblowers have led to an unprecedented number of investigations and greater recoveries. Of the $4.9 billion in fiscal year 2012 recoveries, a record $3.3 billion was recovered in whistleblower suits. In fiscal year 2012 alone, relators filed 647 qui tam suits. Of the nearly 8,500 qui tam suits filed since the 1986 amendments, nearly 2,200 were filed since January 2009. Looking at qui tam recoveries for the same periods, the department tallied $24.2 billion since 1986, with nearly $10.5 billion of that amount recovered from January 2009 through fiscal year 2012. Since 1986, whistleblowers have been awarded nearly $4 billion, with $439 million in awards in fiscal year 2012.

"The whistleblowers who bring wrongdoing to the government’s attention are instrumental in preserving the integrity of government programs and protecting taxpayers from the costs of fraud," said Principal Deputy Assistant Attorney General Delery. "We are extremely grateful for the sacrifices they make to do the right thing."

Acting Associate Attorney General West and Principal Deputy Assistant Attorney General Delery also expressed their deep appreciation for the dedicated public servants who contributed to the investigation and prosecution of these cases. These individuals include attorneys, investigators, auditors and other agency personnel throughout the Civil Division, the U.S. Attorneys’ Offices, HHS, Department of Defense and the many other federal and state agencies that contributed to the department’s record recoveries this past year.

"The department’s record recoveries this past year are a product of the tremendous skill and dedication of the people who worked on these cases and investigations," Mr. Delery said.

HEALTH CARE COMPANY OWNER SENTENCED TO PRISON FOR MEDICARE FRAUD

The following excerpt is from the Department of Justice website:
Wednesday, October 12, 2011
“WASHINGTON – The owner and operator of a Houston durable medical equipment (DME) company was sentenced yesterday in Houston federal court to 33 months in prison for his role in a Medicare fraud scheme, announced the Department of Justice, the FBI and the Department of Health and Human Services (HHS).
Bassey Monday Idiong, 32, of Humble, Texas, was sentenced by U.S. District Judge Vanessa D. Gilmore. In addition to his prison term, Idiong was sentenced to two years of supervised release and was ordered to pay $527,023 in restitution.
Idiong pleaded guilty on March 1, 2010, to one count of conspiracy to commit health care fraud and five counts of health care fraud. Idiong owned and operated B.I. Medical Supply LLC.
According to court documents, Idiong paid patient recruiters kickbacks in exchange for the names of beneficiaries for whom bills could be submitted to Medicare. B.I. Medical billed Medicare for expensive, rigid orthotics and braces that were packaged together and referred to as an “arthritis kit,” at a cost of approximately $4,000 per kit. B.I. Medical then supplied the beneficiaries with different, less expensive products that were not medically necessary. Court documents indicate that in one instance, B.I. Medical billed Medicare for an arthritis kit that included two knee braces for a beneficiary who had only one leg. In total, B.I. Medical submitted approximately $846,000 in fraudulent claims to Medicare.
The sentence was announced by Assistant Attorney General Lanny A. Breuer of the Justice Department’s Criminal Division; U.S. Attorney Kenneth Magidson of the Southern District of Texas; Special Agent-In-Charge Stephen L. Morris of the FBI’s Houston Field Office; Special Agent-in-Charge Mike Fields of the Dallas Regional Office of HHS’s Office of the Inspector General (HHS-OIG), Office of Investigations; Joseph J. Del Favero, Special Agent-in-Charge of the Chicago Field Office of the Railroad Retirement Board Office of Inspector General; and the Texas Attorney General’s Medicaid Fraud Control Unit (MFCU).
The case was prosecuted by Trial Attorneys Laura Cordova, Katherine Houston and Jennifer Saulino of the Criminal Division’s Fraud Section. The case was brought as part of the Medicare Fraud Strike Force, supervised by the U.S. Attorney’s Office for the Southern District of Texas and the Criminal Division’s Fraud Section.
Since their inception in March 2007, Strike Force operations in nine locations have charged more than 1,140 defendants who collectively have falsely billed the Medicare program for more than $2.9 billion. In addition, HHS’s Centers for Medicare and Medicaid Services, working in conjunction with the HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.”

ASSISTANT AG LANNY BREUER SPEAKS ON HEALTH CARE FRAUD

The following remarks were delivered by Assistant Attorney General Lanny A. Breuer at the American Health Layers Association and Health Care Compliance Association’s 2011 Fraud and Compliance Forum. This excerpt is from the Department of Justice website:
“Baltimore ~ Monday, September 26, 2011
Remarks as prepared for delivery:Thank you, Kathleen, for that kind introduction. I am delighted to be here today, and to join you and your colleagues in the health care regulatory and compliance profession on the occasion of this important conference. Fraud is a significant problem in the health care industry, as it is in many other sectors. So coming together, as you are doing this week, to discuss compliance and share best practices, is, I believe, important work, and an essential piece of ensuring that you and your organizations do not run afoul of the many rules that govern your industry.
As the Assistant Attorney General of the Department of Justice’s Criminal Division, I am privileged to lead nearly 600 lawyers who enforce the nation’s federal criminal laws and help to develop and implement our criminal law policy. Prosecutors in the Criminal Division face an extremely broad array of threats – from violence along the Southwest Border and cybercrime, to financial fraud, international narcotics trafficking, and child exploitation. We work hand-in-hand with the 94 U.S. Attorneys’ Offices across the country, including here in Baltimore. My friend, Rod Rosenstein, the U.S. Attorney for the District of Maryland, is a tremendous public servant and prosecutor, and I’m honored that our offices collaborate as frequently as they do on investigations and prosecutions. Just last week, for example, the last defendant in a multi-defendant investigation of the Latin Kings gang in Maryland was sentenced to 22-and-a-half years in prison in one of our joint cases.
As health care compliance professionals, you are fortunate not to have to face the Latin Kings or other violent organizations in your work. At least I hope you don’t have to. But you do face the no less important foe of health care fraud.
In the Criminal Division, and throughout the U.S. Attorneys’ Offices, we devote substantial resources to investigating and prosecuting fraud of all kinds – investment fraud, bank fraud, mortgage fraud, procurement fraud, and, of course, fraud in the health care industry.
As you know, certainly as well as any other group I have had the privilege of speaking with, health care fraud is a significant law enforcement problem. Most doctors, nurses, pharmaceutical companies, and other health care providers are, like you, diligent about complying with the rules and following the law. As we in the Justice Department see every day, however, many others go to extraordinary lengths to commit fraud on government and other health care programs, or on consumers. In every way, we are aggressively fighting back.
In May 2009, Attorney General Eric Holder and Department of Health and Human Services Secretary Kathleen Sebelius announced the creation of the Health Care Fraud Prevention and Enforcement Action Team, or HEAT. With HEAT, the fight against health care fraud has become a Cabinet-level priority. And the results have been extremely strong – both in terms of financial recoveries and criminal convictions. In Fiscal Year 2010, we collectively recovered a record $4 billion on behalf of taxpayers. That amount represented an approximately 57 percent increase over the amount recovered in Fiscal Year 2009, which was itself a record at the time. Also in Fiscal Year 2010, we brought criminal health care fraud charges against 931 defendants – the most ever in a single fiscal year – and we secured 726 convictions, also a record.
At the Justice Department, we have many tools available to us for holding companies and individuals to account in the fight against health care fraud. Together with the U.S. Attorneys’ Offices, the Civil Division, the Civil Rights Division, and the Criminal Division bring dozens of important health care fraud cases every year. And, through its hundreds of personnel dedicated solely to health care fraud investigations, the Federal Bureau of Investigation provides our prosecutors with critical investigative support.
The Civil Division aggressively pursues civil enforcement actions aimed at rooting out waste, fraud, and abuse in the health care industry, often, by its Fraud Section, through use of the False Claims Act. Through its Consumer Protection Branch, or CPB, the Civil Division also frequently invokes the Food, Drug and Cosmetic Act, which authorizes both civil and criminal actions. CPB pursues, among other violations, the unlawful marketing of drugs and medical devices, fraud on the Food & Drug Administration, and the distribution of adulterated products. As one example of the Civil Division’s work, the Department reached settlements last December with multiple pharmaceutical manufacturers, who agreed to pay more than $700 million to resolve False Claims Act allegations that they had reported false and inflated prices for many of their products, knowing that federal health care programs such as Medicare and Medicaid relied on those reported prices to set payment rates. As another example, the pharmaceutical manufacturer GlaxoSmithKline agreed last year to pay $750 million in criminal penalties and civil recoveries to resolve an investigation concerning a GSK subsidiary. The subsidiary, SB Pharmco Puerto Rico Inc., pleaded guilty to charges relating to the manufacture and distribution of certain adulterated drugs made in GSK’s now-closed plant in Cidra, Puerto Rico.
The Civil Rights Division is responsible for enforcing the Civil Rights of Institutionalized Persons Act, or CRIPA. CRIPA authorizes the investigation of conditions of confinement at state and local residential institutions and the initiation of civil actions for injunctive relief to remedy a pattern or practice of constitutional or federal statutory violations at such institutions. In Fiscal Year 2010, the Civil Rights Division’s Special Litigation Section opened or continued formal investigations, entered remedial agreements, or monitored existing remedial agreements, in connection with 71 health care facilities in 25 states, the District of Columbia, the Territory of Guam, and the Commonwealth of Puerto Rico.
Both the Civil and Civil Rights Divisions, which are doing such important work in this area, have the benefit of being led by extraordinarily talented lawyers and leaders – my friends Tony West in the Civil Division and Tom Perez in the Civil Rights Division.
Finally, the Criminal Division is primarily responsible for the Department’s Medicare fraud prosecutions, which have been extraordinarily aggressive in recent years. In 2007, the Criminal Division, together with the U.S. Attorney’s Office in Miami and the Miami Divisions of the FBI and HHS’s Office of Inspector General, launched the Medicare Fraud Strike Force, to root out fraud and abuse among durable medical equipment suppliers and HIV infusion therapy providers in South Florida. The Strike Force uses data analysis techniques to identify aberrational billing patterns in Strike Force cities, permitting law enforcement teams to target emerging or migrating schemes, along with chronic fraud by criminals operating as health care providers or suppliers. In 2008, the Strike Force expanded to Los Angeles; and in 2009, when Attorney General Holder and Secretary Sebelius announced the HEAT initiative, we expanded the Strike Force to Houston and Detroit. Today, we have Strike Force teams in nine cities around the country.
The Strike Force has been relentless in its efforts. Over the past 14 months, we have carried out the three largest Medicare fraud takedowns in history. In July 2010, we announced criminal charges against 94 defendants, in five Strike Force cities. These defendants were charged with submitting more than $251 million in false claims to the Medicare program.
In February of this year, we announced charges against more than 110 defendants, in all nine Strike Force cities. These defendants were charged with defrauding Medicare of over $240 million.
And, earlier this month, we announced charges against 91 defendants in eight Strike Force cities; we alleged that these defendants collectively submitted approximately $295 million in fraudulent billings to the Medicare program. This was the largest Medicare fraud takedown ever, as measured by the amount of fraudulent billings.
You might like to think that the defendants in these cases are unsophisticated criminals. But, as we have found time and again, they cover nearly the entire spectrum of healthcare providers. For example, in connection with this month’s takedown, we charged a doctor in Detroit with allegedly billing Medicare for performing psychotherapy treatments more than 24 hours per day. He is also charged with billing the Medicare program for services provided to dead beneficiaries. We also charged a supervisor at a community mental health center in Miami with threatening to evict residents of a boarding house he also managed, unless they attended the center. A registered nurse, mental health counselors, and other healthcare professionals were charged with participating in the same scheme, which allegedly resulted in the submission of over $50 million in fraudulent billings to Medicare.
These are serious crimes. People who defraud Medicare and other government health care programs are not only stealing from American taxpayers, but they are also often jeopardizing the health of patients in need. As we have increased our enforcement, courts have begun to respond in kind. Ten days ago, for example, the owner of a mental health care company in Miami, who pleaded guilty to orchestrating a $205 million Medicare fraud scheme, was sentenced to 50 years in prison. Fifty years. Three days later, the company’s co-owner was sentenced to 35 years in prison. In June, a Miami doctor was sentenced to nearly 20 years in prison for his participation in a multi-million dollar HIV injection and infusion Medicare fraud scheme. In that case, the physician ordered unnecessary tests, signed medical analysis and diagnosis forms, and authorized treatments to make it appear that patients were receiving services reimbursable by Medicare when, in fact, they were not. He signed patient charts indicating that infusion treatments were medically necessary, when, in fact, they were not. In many cases, he had not even seen the patient whose chart he was signing. For his efforts to cheat Medicare out of millions of dollars in this way, he received $3,000 per week from one of his co-conspirators.
The criminal sanction is not appropriate in every circumstance. Every time that we decide to indict someone – and therefore potentially take away his or her liberty – we must be able to prove beyond a reasonable doubt that the defendant committed a crime. In Medicare fraud cases, we must be able to prove that the defendant intended to defraud the Medicare program. Negligence, and even recklessness, are not enough. Our system of justice does not permit us to bring criminal charges against a defendant whom we do not like, or because we believe that he or she exhibited excessive greed or took excessive risks. But – and this you can be sure of – in the area of Medicare fraud, as in every other area to which we devote prosecutorial resources, if we have the evidence, we will bring the charges.
To take just the most recent example, you can see this in our relentless efforts to eliminate traditional organized crime. This past Friday, I was in Rhode Island, where I announced, along with the U.S. Attorney in Providence, charges against four members and associates of the New England La Cosa Nostra – what people more commonly refer to as the mafia. That announcement followed several earlier indictments this year, including the largest enforcement action ever taken against La Cosa Nostra in the United States, in January, when we arrested over 125 people in four districts on charges ranging from racketeering and murder to extortion and drug trafficking. You can also see it in our financial fraud prosecutions, which have resulted in hundreds, if not thousands of people going to prison for defrauding investors, mortgagees, banks, and others.
And, of course, you can see it in the Medicare fraud context. Indeed, if there is one message I want to leave you with today, it is that the era of getting away with Medicare fraud is over. With the HEAT initiative, we have adopted an inter-agency approach that calls upon the expertise of HHS, including the investigative strengths of its Inspector General’s Office, and on the civil and criminal prosecutorial abilities of the Justice Department. The government as a whole is coordinating like never before to take on the problem of health care fraud. I know that Attorney General Holder and Secretary Sebelius are committed to rooting out health care fraud wherever it lurks. As the head of the Justice Department’s Criminal Division, I am personally committed to holding individuals and institutions that defraud the Medicare program to account for their crimes. By your presence here, I know that you, too, are committed to minimizing fraud in the health care industry. I commend you for that, and urge us to continue this important fight together. Thank you.”