107 charged in $452 million Medicare fraud

MIAMI — Federal authorities charged 107 doctors, nurses and social workers in seven cities with Medicare fraud Wednesday in a nationwide crackdown on unrelated scams that allegedly billed the taxpayer-funded program of $452 million — the highest dollar amount in a single Medicare bust in U.S. history.

It was the latest in a string of major arrests in the past two years as authorities have targeted fraud that’s believed to cost the government between $60 billion and $90 billion each year. Stopping Medicare’s budget from hemorrhaging that money will be key to paying for President Barack Obama’s health care overhaul.

Health and Human Services Secretary Kathleen Sebelius and Attorney General Eric Holder partnered in 2009 to increase enforcement by allocating more money and staff and creating strike forces in fraud hot spots.

On Wednesday, hundreds of federal agents fanned out around the country, raiding businesses, seizing documents and charging 107 suspects in Miami, Los Angeles, Houston, Detroit, Chicago, Tampa, Fla., and Baton Rouge, La. The government suspended payment to 52 providers as part of the investigations.

“When President Obama took office he asked Attorney General Holder and me to make fraud prevention a cabinet-level priority,” Sebelius said in remarks prepared for a news conference in Washington.

Among those arrested Wednesday were the owners of two community mental health centers in Baton Rouge, charged with billing $225 million in their scams. Hoor Naz Jafri and Roslyn Dogan allegedly recruited vulnerable patients, including elderly people, drug addicts and the mentally ill. Patient charts were doctored to show services that were billed to Medicare but often never given, according to an indictment.

Authorities suspended their companies in May 2011, but the pair continued billing Medicare after purchasing another fraudulent company, according to the indictment. When feds shut down that company, the pair tried to sell their “beneficiaries” to other providers in an attempt to keep making money.

During the investigation, federal authorities tried to put a hold on the company’s bank account. Dogan asked to visit the U.S. Attorney’s Office to review and copy documents that had been seized as part of a search. After the visit, “Dogan and co-conspirators bragged that, while pretending to copy files, they actually stole incriminating documents from the files and later destroyed them.” Dogan referred to herself as a “smooth criminal,” according to the indictment.

Another co-conspirator bragged to Dogan and others that he had a “bonfire with fabricated notes that law enforcement officers had failed to seize during the search,” according to the indictment.

They could face life in prison if convicted. A woman who answered the phone at one of the companies hung up and an email to the company was not immediately returned.

Five others were charged in connection with the Baton Rouge scam, capping a six-year investigation.

“The results we are announcing today are at the heart of an administration-wide commitment to protecting American taxpayers from health care fraud,” said Attorney General Eric Holder. “We are determined to bring to justice those who violate our laws and defraud the Medicare program for personal gain.

More than 50 defendants were also arrested in Miami in unrelated scams totaling $136 million involving community mental health centers and home health care agencies. A handful of those arrested also had criminal backgrounds, according to federal agents.

Community mental health centers are the latest trend in Medicare fraud, which has developed more complex schemes over the years, moving from medical equipment and HIV infusion fraud to ambulance scams, as crooks try to stay one step ahead of authorities. The scams have also grown more sophisticated using patient recruiters who are paid kickbacks for recruiting patients, while doctors, nurses and company owners coordinate to make it appear they are delivering medical services which they are not.

“Medicare fraud also exposes some of our most vulnerable citizens to identity theft, and, in some cases, endangers patients’ lives,” said Gary Cantrell, Deputy Inspector General for Investigations for HHS. “The indictments announced today demonstrate that we’re fighting back.”

Wednesday’s arrests come as top lawmakers appealed to health care professionals in the private sector to help combat Medicare fraud. Six members of the Senate Finance Committee, led by Ranking Member Orrin Hatch (R-Utah) and Chairman Max Baucus (D-Mont.), announced a bipartisan effort to begin soliciting ideas from interested stakeholders in the health care community looking for a fresh perspective and potentially solutions that may have been overlooked.

“To date, numerous efforts have been made to reduce fraud, yielding a mixed record of successes and failures,” according to the letter.

Sebelius said her agency and the Justice Department have more than quadrupled the number of strike teams around the country, charging hundreds of individuals with Medicare fraud.

Medicare fraud has been a hot button issue as federal officials have repeatedly come under fire for seemingly staying one step behind the criminals, using outdated technology and not coordinating efficiently with law enforcement.

But Sebelius touted a new data system that will allow authorities to spot trends in billing patterns more quickly, which will ideally stop payments before they go out the door.

The Centers for Medicare and Medicaid Services launched a $77 million computer system last summer to serve that purpose, but the program has yielded few results in the early stages and drawn criticism from the Senate Finance Committee.

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