More than 400 people charged in $1.3 billion federal health fraud sweep, including two in Massachusetts
The enforcement action, which also swept up two defendants in Massachusetts, has led to charges against 115 medical professionals and suspension actions for 295 doctors, nurses and pharmacists, the DOJ said in a press release.
And 120 of the defendants were charged in connection with the prescription of opioids and other narcotics.
"Too many trusted medical professionals like doctors, nurses and pharmacists have chosen to violate their oaths and put greed ahead of their patients," Attorney General Jeff Sessions said in a statement. "Amazingly, some have made their practices into multimillion dollar criminal enterprises. They seem oblivious to the disastrous consequences of their greed. Their actions not only enrich themselves often at the expense of taxpayers but also feed addictions and cause addictions to start."
The Massachusetts Attorney General's Office coordinated with federal authorities on the investigation and arrested two people on Monday who allegedly stole $2.7 million from the state's Medicaid program.
Elena Kurbatzky, 44, of Boston, and 43-year-old Natan Zalyapin of Burlington are facing multiple counts of Medicaid false claims and larceny for allegations that their company, Harmony Home Health Care, billed Medicaid for nursing services that were not actually provided.
"The AG's investigation revealed that between February 2015 and October 2016, Harmony billed MassHealth for home health services allegedly provided to 38 patients, but either provided no services to those patients or billed for more services than were actually provided," the Attorney General's Office said in a statement. "Specifically, authorities allege that on numerous instances, Harmony billed MassHealth for nurses who allegedly provided services to several patients in different locations at the exact same time, so those services could not physically have been performed as claimed."
The investigations focused on providers who submitted false claims to Medicare, Medicaid and TRICARE, a health program for service members and veterans. Some treatments were allegedly medically unnecessary and others were never provided at all, the DOJ said.
And many of the schemes allegedly involved the payment of kickbacks to patient recruiters and beneficiaries in exchange for patient information that could be fraudulently submitted to federal health programs, according to the DOJ.
"This week, thanks to the work of dedicated investigators and analysts, we arrested once-trusted doctors, pharmacists and other medical professionals who were corrupted by greed," Acting FBI Director Andrew McCabe said. "The FBI is committed to working with our partners on the front lines of the fight against heath care fraud to stop those who steal from the government and deceive the American public."
The bulk of the charges stemmed from federal investigations, by both U.S. attorneys offices and the Department of Justice and the Department of Health and Human Service's Medicare Fraud Strike Force. 77 people were charged in the Southern District of Florida, 32 in the Eastern District of Michigan and 26 in the Southern District of Texas due to strike force actions, the DOJ said.
"In one case, the owner and operator of a purported addiction treatment center and home for recovering addicts and one other individual were charged in a scheme involving the submission of over $58 million in fraudulent medical insurance claims for purported drug treatment services," the DOJ said. "The allegations include actively recruiting addicted patients to move to South Florida so that the co-conspirators could bill insurance companies for fraudulent treatment and testing, in return for which, the co-conspirators offered kickbacks to patients in the form of gift cards, free airline travel, trips to casinos and strip clubs, and drugs."
But in some states -- including Massachusetts -- the charges were driven by state-level Medicaid Fraud Control Units, who coordinated with federal authorities.
Statistics released by the Justice Department show a steady rise in arrests linked to federal health care fraud investigations, from 89 in 2013, to 301 last year, to 412 so far in 2017.