- The Justice Department says it has executed "an unprecedented nationwide sweep" of 36 federal districts.
- As a result, 301 people, including 61 doctors, nurses and other licensed medical professionals, were charged for alleged participation in healthcare fraud schemes.
- The sweep involved approximately $900 million in false billings. The DOJ referred to it as "the largest in history, both in terms of the number of defendants charged and loss amount."
In addition, CMS is suspending payment to a number of providers using its suspension authority provided in the ACA.
The defendants are charged with various healthcare fraud-related crimes, including conspiracy to commit healthcare fraud, violations of the anti-kickback statutes, money laundering and aggravated identity theft.
The charges are based on a variety of alleged fraud schemes involving various medical treatments and services, including home health care, psychotherapy, physical and occupational therapy, durable medical equipment (DME) and prescription drugs.
The Medicare Fraud Strike Force swept through territories including Florida, Texas, California, Michigan, Illinois, New York, and Louisiana.
Increasingly, organized rings are colluding to commit healthcare fraud, requiring hospitals and health systems to adopt increasingly sophisticated tools crack them. As Utpal Bhatt, vice president of marketing at the San Mateo, CA-based firm Neo Technologies, recently told Healthcare Dive, graph databases are particularly useful in capturing large fraud rings, such as those targeting Medicare and Medicaid, because of the ability to conduct entity-link analysis.
Mitre Corp. is using Neo Technologies’ Neo4j -- which gathers data and presents them as a set of related events -- to identify patterns in the relationship between doctors and their patients that could point to drug abuse.
DOJ remarked that the strike force is a model of data-driven law enforcement. HHS Secretary Sylvia Burwell chimed in on Twitter to announce nearly 1,000 federal agents used "advanced analytics" to find and expose the alleged individuals. She added since the strike force began in 2007, more than 2,900 defendants have been charged with defrauding Medicare of more than $8.9 billion.