Medicare Fraud Sting Operation in Detroit

On June 24, a federal grand jury in the Eastern District of Michigan indicted 53 Metro-Detroiters for allegedly submitting false Medicare claims totaling over $50 million. The sting operation undertaken by the Medicare Fraud Strike Force in Detroit, was coordinated by the Department of Health and Human Services Healthcare Fraud Prevention and Enforcement Action Team (HEAT) and is but one phase in a multi-phase initiative to reduce Medicare and Medicaid fraud. The indictments include conspiracy to defraud the Medicare program, criminal false claims, and violations of the anti-kickback statutes. According to the Department of Health and Human Services (HHS), the defendants “participated in schemes to submit claims to Medicare for treatments that were in fact medically unnecessary and oftentimes, never provided.” Detroit is just one place authorities have targeted as part of the HEAT initiative, which has already indicted over 250 people in Florida, Los Angeles, and Miami.

According to the Medicare Fraud Strike Force, maximum prison sentences range from 2 to 20 years, per count. In addition to incarceration, the defendants are also facing criminal restitution (i.e., paying back the amounts proven by the government to have been unlawfully received), civil fines (e.g., treble damages), administrative sanctions (e.g., exclusion from the Medicare and Medicaid programs), and potential loss of health care licenses (if applicable). For many individuals, multiple counts of healthcare fraud–each count which carries a maximum prison sentence of 10 years–could, essentially, be a life sentence. For instance, one individual has been charged with 1 count of conspiracy to commit healthcare fraud, 3 counts of healthcare fraud, 1 count of conspiracy to launder money, and 6 counts of money laundering. If she is convicted on just the 6 counts of money laundering, she could face up to 60 to 120 years in prison (depending on which money laundering statute she has been proven to have violated). For someone in her 50s, this would essentially be a life sentence.

For more information, please call Abby Pendleton, Esq., Robert Iwrey, Esq., Adrienne Dresevic, Esq., Carey F. Kalmowitz, Esq. or Jessica L. Gustafson, Esq. at (248) 996-8510 or visit The HLP website.