15 Charged in Alleged $2 Billion Medicare and Insurance Fraud Schemes

Federal prosecutors have charged 15 individuals across multiple states in connection with alleged Medicare and insurance fraud schemes that collectively amounted to $2 billion, the Justice Department announced Thursday.

Eight of the defendants were arrested by federal agents, with most of the arrests occurring in California, according to officials. The alleged schemes involved a range of fraudulent activities, including billing private insurers for fictitious substance abuse treatment, submitting false claims to Medicare for unnecessary atherectomy procedures, and charging Medicare for hospice services for patients who were not terminally ill.

Five of the suspects were slated to appear in federal court in Los Angeles, two in federal court in Texas, and another in federal court in Illinois on Thursday afternoon. Attorney information for the suspects was not immediately available.

The largest alleged scheme involved two individuals in Los Angeles and one in Texas who are accused of orchestrating a years-long operation to bring substance abuse patients from across the country to California. The suspects allegedly enrolled these patients in ineligible insurance policies to obtain the highest reimbursement rates for substance abuse treatments, amassing over $1.6 billion, the Justice Department stated.

In a separate case, a Los Angeles cardiothoracic surgeon and a chiropractor are accused of falsely diagnosing patients with arterial disease and recommending unnecessary atherectomy procedures. This case involved billing Medicare for over $135 million for these procedures, according to the Justice Department.

Furthermore, three separate cases allege that suspects billed Medicare a combined $138 million for fraudulent hospice schemes. These individuals are accused of providing hospice services to patients who were not terminally ill.