My Philly Daily On Crime Column: Dozens Charged With Healthcare Fraud In Cases Involving $5.76 Million Billed To Pennsylvania’s Medicaid Program

 Philly Daily ran my On Crime column today on health care fraud. 

You can read the column via the link below or the following text:

Paul Davis: Dozens charged with healthcare fraud in cases involving $5.76 million billed to Pennsylvania’s Medicaid program – Philly Daily

Back in April, Dr. Mehmet Oz (seen in the top photo), the administrator of the Centers for Medicare & Medicaid, unveiled a nationwide plan to crack down on Medicaid fraud.

The United States Attorney in Philadelphia, David Metcalf (seen in the above photo), announced earlier this month that 12 individuals and an agency have been charged by federal indictment and additional defendants were charged by the Pennsylvania Office of Attorney General with health care fraud and other offenses, for allegedly conspiring to defraud the Pennsylvania Medicaid program.

Metcalf discussed the cases at a news conference alongside Assistant Attorney General Colin McDonald of the Department of Justice’s National Fraud Enforcement Division; Pennsylvania Attorney General Dave Sunday; Scott Brady, Executive Director of the White House Task Force to Eliminate Fraud; Dr. Mehmet Oz, Administrator of the Centers for Medicare and Medicaid Services; T. March Bell, Department of Health and Human Services Inspector General; Wayne Jacobs, Special Agent in Charge of FBI Philadelphia; Stanley Rutkowski, Assistant Special Agent in Charge of Health and Human Services Office of Inspector General (“HHS-OIG”), Philadelphia Regional Office; Timothy Flaherty, Special Agent in Charge of DEA Philadelphia; and Larry Arrow, Assistant Special Agent in Charge of IRS Criminal Investigation (“IRS-CI”) in Philadelphia.

“The great fraud against the American taxpayer takes many forms,” Metcalf said. “It is outrageous and unacceptable that anyone could steal money by billing nonexistent home care services for caregivers who were, in fact, dead, in prison, or trafficking drugs.”

According to the announcement, AAG McDonald announced a significant expansion of the Fraud Division’s Northeast Health Care Fraud Strike Force to Philadelphia, an enforcement initiative uniting the Division’s Health Care Fraud Section with the U.S. Attorney’s Office.

According to the U.S. Attorney’s Office, 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.

The U.S. Attorney’s Office noted that the Strike Force’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. Philadelphia and its surrounding areas have vibrant and cutting-edge health care technology and insurance industries, and 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.

“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 McDonald. “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.”

“The magnitude of home care fraud is shocking and requires the total force of the United States government to solve,” Metcalf said. “This is why we are excited to announce the return of the Philadelphia Fraud Strike Force, partner with the National Fraud Enforcement Division, and enhance our alliance with Pennsylvania Attorney General Dave Sunday.”

According to the U.S. Attorney’s Office, the Eastern District of Pennsylvania has become the target of fraudsters seeking to take advantage of Medicaid’s home health care funds, which should be devoted to assisting elderly and ill Pennsylvanians to age in place with dignity. Today’s announcement is a result of coordinated and dedicated investigations and prosecutions at the federal and state levels.”

The law enforcement partners went on to detail the cases of Medicaid fraud that were the focus of the takedown.

“This criminal conduct is much more than someone ‘working the system’ — the impact is deep and wide-ranging, as every dollar diverted deprives someone in need of care,” Pennsylvania Attorney General Dave Sunday said. “In collaboration with our partners, my office last year convicted more than 100 defendants, and clawed back more than $40 million that was intended for Pennsylvanians in need.”

“Medicaid fraud robs hardworking taxpayers, deprives vulnerable Americans of the care they need, and undermines the public trust that sustains our social safety net,” said CMS Administrator Dr. Mehmet Oz. “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.”

“Health care fraud is not a victimless crime — it undermines public trust and diverts critical resources from patients who need them,” said FBI Philadelphia Special Agent in Charge Wayne Jacobs. “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, and the FBI will continue its work to safeguard the public's trust and hold accountable those who abuse these vital programs.”

Paul Davis’s On Crime column appears here each week. He is also a contributor to Broad + Liberty and Counterterrorism magazine, He can be reached via pauldavisoncrime.com.