The Justice Department on Thursday announced charges against 15 defendants, including six medical professionals, for health care fraud schemes that it says collectively resulted in over $1.8 billion in fraudulent claims to government and private health care programs. Eight defendants were arrested on Thursday, six of whom were expected to make initial appearances at the US District Court in downtown Los Angeles and two at a US District Court in Texas, the department said.

Source: US Department of Justice

The largest case, which the department called the largest sober home fraud scheme it has ever prosecuted, involves over $1.6 billion billed in an alleged scheme to lure vulnerable individuals to California for sham substance abuse treatment. Prosecutors allege that Nathan Young, David Young, Honey Phipps and Cody Phipps targeted people who were homeless, impoverished or attending recovery groups, and that recruiters offered flights, housing, money, gift cards, cigarettes, marijuana and other drugs to induce enrolment, The American Quorum reported from the charging documents. Insurers paid more than $210 million on the claims, that report said. In a related admission, Nicholas Moore, described by prosecutors as an area manager, pleaded guilty and admitted helping submit $199 million in fraudulent claims, according to the Justice Department account reported by Agentic Tribune.

Source: The American Quorum

In a second major case, prosecutors allege that $134 million was fraudulently billed to Medicare for unnecessary atherectomy procedures — an invasive procedure that clears plaque from arteries — and that the procedures resulted in injury to patients. Fox News reported that the defendants in that case are Dr. Harold Tabaie, 78, of Anaheim, a cardiothoracic surgeon, and his business partner Hany Malek, 61, a Tarzana chiropractor, and that prosecutors allege Malek posed as a medical doctor to diagnose patients with arterial disease and recommend atherectomies even though the patients did not have the condition.

Source: Fox News

The remaining cases include over $138 million allegedly billed to Medicare in three different hospice fraud schemes where the patients were not terminally ill, and a separate indictment of another defendant previously charged by complaint in an alleged $270 million scheme to defraud Medi-Cal, California's Medicaid program, through pharmacy claims for bogus prescriptions, the Justice Department said. “These charges include the largest sober home fraud scheme the Department has ever prosecuted, and a scheme involving unnecessary invasive procedures detected through data analytics,” said Assistant Attorney General Colin M. McDonald of the department's National Fraud Enforcement Division. “If you steal health care dollars from the American taxpayer or abuse your position to harm patients, we are coming for you.” All of the charges are allegations; the defendants are presumed innocent unless and until proven guilty in court.

Source: US Department of Justice