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Charges against 301 Individuals for Approximately $900 Million in False Billing

Just recently, the Department of Health and Human Services Office of Inspector General (OIG) announced the largest health care fraud takedown in history. Specifically, in June 2016, the OIG along with state and federal law enforcement partners participated in a takedown involving approximately 300 defendants in 36 judicial districts being charged with participating in fraud schemes involving about $900 million in false billings to Medicare and Medicaid.

According to the report, the defendants announced today are charged with various health care fraud-related crimes, including conspiracy to commit health care fraud, violations of the anti-kickback statutes, money laundering and aggravated identity theft. The charges are based on fraud schemes involving various medical treatments and services, including home health care, psychotherapy, physical and occupational therapy, durable medical equipment (DME) and prescription drugs.

“While it is impossible to accurately pinpoint the true cost of fraud in federal health care programs, fraud is a significant threat to the programs’ stability and endangers access to health care services for millions of Americans,” said Inspector General Daniel Levinson of the HHS Office of Inspector General (OIG).  “As members of the joint Strike Force, OIG will continue to play a vital role in tracking down these criminals and seeing that justice is done.”

The report also stated that for every $1.00 spent on health care related fraud and abuse investigations in the last three years, more than $6.10 was recovered.

Did you know?

The OIG has the authority to seek civil monetary penalties (CMPs), assessments, and exclusion against an individual or entity based on prohibited conduct â€" such as fraudulent billings to Medicare and Medicaid.

All entities contracted to perform work related to Medicare programs are required to have appropriate policies and procedures to address fraud, waste, and abuse. Initial training and education on Corporate Compliance and fraud, waste and abuse training should be completed during the orientation process for new employees. All employees should complete annual General Corporate Compliance refresher training thereafter.

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