The Justice Department’s National Fraud Enforcement Division (Fraud Division) announced a major investment in combatting Medicaid fraud through a significant expansion of the Division’s Northeast Health Care Fraud Strike Force to Philadelphia, Pennsylvania, an enforcement initiative uniting the Division’s Health Care Fraud Section with the U.S. Attorney’s Office for the Eastern District of Pennsylvania. The Health Care Strike Force model has proven to be one of the most powerful tools in the federal enforcement arsenal, responsible nationally for the prosecution of over 6,200 defendants who collectively billed federal health care programs and private insurers more than $45 billion.
Key details of the case
In connection with the announcement, the Fraud Division, U.S. Attorney’s Office. Pennsylvania Attorney General today announced criminal charges against 19 defendants, including owners and employees of home care companies, for their alleged participation in various fraud schemes involving over four million dollars in claims to Medicare and Medicaid.
Moreover, the Pennsylvania Attorney General also announced a plea agreement involving the final defendant in a previously-charged 21 defendant case involving over $1.7 million in claims. The Fraud Division’s expansion into the Eastern District of Pennsylvania brings enhanced federal resources to a district with an established tradition of strong health care fraud enforcement. The partnership between the Fraud Division and the Eastern District of Pennsylvania will uniquely enable law enforcement to combat criminals who hide behind corporations to commit fraud.
Meanwhile, philadelphia and its surrounding areas have vibrant and cutting-edge health care technology and insurance industries. The Eastern District of Pennsylvania has long been a prime venue for private lawsuits that bring unlawful corporate conduct in the health care industry to the attention of law enforcement. The Unit’s corporate enforcement efforts align closely with the U.S.
Enforcement actions and official statements
Attorney’s Office in the Eastern District of Pennsylvania and its history of successful criminal and civil actions against corporate bad actors operating in the health care industry. In particular, the Health Care Fraud Unit has significantly expanded its focus on corporate accountability, resolving cases against companies engaged in systemic illegal conduct, including recent corporate resolutions with AP of South Florida LLC, Atlantic Biologicals Corp., ExThera, and Troy Health Inc. Just last week, the Fraud Division announced the first declination of a health care company under the new Department-wide Corporate Enforcement Policy.
As a result, resulted from a voluntary self-disclosure by eye care group Campus Eye. “Home care funding exists to assist America’s elderly and most vulnerable. Not to fund schemes in which aides claim be providing care while incarcerated or vacationing in Miami and Saudi Arabia,” said Assistant Attorney General Colin M. For complete details, refer to the official DOJ press release.
McDonald of the Justice Department’s National Fraud Enforcement Division. “Today’s charges and the expansion of our Northeast Strike Force into the Eastern District of Pennsylvania send a clear message to fraudsters in the region: the Department of Justice will relentlessly pursue you and use all available tools to protect Medicaid and the programs everyday Americans rely on.”. “Medicaid fraud robs hardworking taxpayers, deprives vulnerable Americans of the care they need.
Undermines the public trust that sustains our social safety net,” said CMS Administrator Dr. “CMS will continue partnering with law enforcement to shut down these scams while establishing new anti-fraud safeguards that flag criminal activity before the money ever leaves the building. This Administration is taking a whole-of-government approach to protecting Medicaid—ensuring the program serves the Americans who depend on it, not criminals seeking to exploit it.”. For related coverage, see Russia Under the European Union’s Sanctions Regime Since 2014.
Specifically, “Home care fraud is everywhere, and the victim is all of us taxpayers. Medicaid claims data and the experience of veteran prosecutors all point to the systematic exploitation of reimbursable home care programs,” said U.S. Attorney David Metcalf for the Eastern District of Pennsylvania.
Subsequently, “Today, we sound the alarm on the scale of this fraud by announcing some truly egregious cases, in which numerous people are charged with filing fraudulent claims for caregivers who were not actually providing home care services. In fact were dead, in prison, or trafficking drugs. This racket ends today.”. For related coverage, see Texas laboratory, former CEO, and florida businessman pay a total of $36.4m to settle allegations of kickbacks and unnecessary genetic testing — DOJ.
At the same time, “Health care fraud is not a victimless crime – it undermines public trust and diverts critical resources from patients who need them,” said Special Agent in Charge Wayne A. Jacobs of the FBI Philadelphia Field Office. “No single agency can tackle complex health care fraud schemes alone.
Let today’s announcement be a warning to those engaging in similar activity: if you seek to exploit our health care systems for personal profit, you should expect the FBI and our partners to uncover your scheme and bring it to an end. Every dollar stolen through fraud is a dollar diverted from patient care. The FBI will continue its work to safeguard the public's trust and hold accountable those who abuse these vital programs.”.
Today’s announcement. Charges company owners, home health aides, and Medicaid recipients, including individuals with significant criminal records, shows the diversity of the Fraud Division’s work and its emphasis on full-spectrum accountability. The Strike Force’s expansion makes clear that the Fraud Division will use every available legal tool to identify, investigate.
Investigation and prosecution details
Prosecute offenses against the American people. The Fraud Division and its partners in the Eastern District of Pennsylvania and the Pennsylvania Office of the Attorney General will pursue anybody who seeks to profit at the expense of American taxpayers, regardless of whether the wrongdoing is in the boardroom or in the sickroom. With the newly expanded Northeast Strike Force, the District will have the resources to pursue these allegations and ensure that corporate criminal actors are brought to justice. Recently, the Eastern District of Pennsylvania has become the target of fraudsters seeking to take advantage of Medicaid’s home care funds.