LOS ANGELES – California Department of Insurance detectives were among the many state and federal law enforcement officers who assisted in an unprecedented nationwide sweep targeting health care fraud. The sweep, announced on June 22, 2016, resulted in 301 people being charged (including 61 doctors, nurses and other licensed medical professionals). The investigations revealed health care fraud schemes involving approximately $900 million in false billings. Arrests were made across the country, including 22 in California which included five physicians, a psychiatrist, a pharmacist and an occupational therapist.
“It is preposterous, that medical professionals whom we trust with our health and wellbeing, would be ripping off taxpayers and the country this way,” said California Statewide Law Enforcement Association (CSLEA) President Alan Barcelona. “This coordinated takedown is said to be the largest in history, both in terms of the number of suspects charged and the dollar amount lost. I commend our insurance detectives for assisting in this vital effort to find those who are abusing public funds for their own personal financial gain.”
The California cases involved various schemes that led to more than $161 million in fraudulent bills being submitted to publicly funded health care programs such as Medicare and TRICARE. Some of the schemes involved compounding pharmacies and kickbacks to doctors who prescribed medicine for patients who either did not want the medicine or had no idea it was being prescribed for them. Some of the suspects allegedly participated in schemes to submit claims to Medicare and Medicaid for treatments that were medically unnecessary and often never provided. In one case, a doctor was charged with causing nearly $12 million in losses to Medicare through his own fraudulent billing, including performing medically unnecessary vein ablation procedures on Medicare beneficiaries.
