As always, the contents of this blog constitute a compendium of multiple media reports supplemented by my personal opinion, where indicated.
As most of you know, the Department of Justice in conjunction with various other federal agencies has been investigating allegations of massive, pervasive, Medicare fraud throughout the US. This problem first came to light some months ago with the disclosure of alleged fraud in Minnesota. Federal and state authorities have been conducting massive, ongoing investigations into Medicare and Medicaid fraud in that state. The Department of Justice (DOJ) and the Minnesota Attorney General’s Office have executed what the media has described as a series of “historic joint takedowns” of dozens of individuals and medical providers allegedly participating in extensive schemes involving false claims totaling hundreds of millions of dollars. It has been further alleged that politicians such as Governor Tim Walz, Attorney General Keith Ellison, Congresswoman Ilhan Omar and others were cognizant of these schemes but chose to turn a “blind eye” for political reasons. Most of the media has underreported this matter, but now it has burst wide open.
It has long been suspected that this fraud was not limited to MN. Accordingly, the DOJ has been conducting its own countrywide investigation. Last Tuesday the DOJ announced what it termed the “2026 National Health Care Fraud Takedown.” This historic nationwide enforcement action charged 455 defendants, including 90 medical professionals, across 45 states for allegedly submitting $6.5 billion in false Medicare and Medicaid claims. Officials said cases were filed in 56 federal districts and territories, with all 50-state Medicaid Fraud Control Units participating. The blatant and brazen degree of audacity and greed will make your blood boil especially considering that many of the victims are the weakest and most defenseless among us – the sick, the elderly and children. Acting AG Todd Blanche described it as “the greatest combined federal and state effort combatting healthcare fraud in history.”
The MN scheme was particularly egregious since it funneled money to Somali nationals, many of whom were in the US illegally to boot, who, in turn, funneled the funds to Somali terrorist organizations located in Somalia.
These schemes come in many forms, but the most common one is medical identity theft combined with fraudulent billing. Typically, fraudsters steal Medicare numbers, which enables them to bill the government illegally for expensive medical treatments, tests, or equipment that were never needed, requested, or provided.
A few of the many examples:
- Los Angeles is a hotbed of abuse. HHS Secretary Robert F. Kennedy, Jr. characterized LA as a “hive of hospice fraud” denoting, tongue in cheek, that an inordinate number of hospice patients “never die.” The Anti-Fraud Task Force headed up by VP JD Vance suspended payments to approximately 800 hospices and home health agencies in the city. Additionally, federal prosecutors have commenced criminal charges against ten doctors who were illegally prescribing controlled substances.
- Businessman Ibrahim Khaldoon Hilmi is accused of running a medical supply business that submitted $3.7 billion in false claims for equipment that patients never received.
- Nurse practitioner Marizel Yukee won the dubious prize for the highest level of fraud. According to the indictment, she is accused of billing $906 million for medically unnecessary treatments. She owned mobile clinics in four states from which she targeted elderly Medicare patients many of whom were terminally ill and under hospice care. Moreover, she allegedly billed for medically unnecessary amniotic wound treatments that were applied to vulnerable patients through an illegal kickback and bribery scheme. Authorities allege the treatments were applied to infected wounds, wounds that had already healed and wounds that were not responding to treatment. Prosecutors also allege that she falsified patient records to make it appear that these procedures complied with Medicare requirements. Authorities seized much of her property that she had acquired through these schemes, including a $594,000 Ferrari and an $865,000 necklace.
- Last year the federal authorities recovered nearly $220 million from the State of Texas related to criminal and civil Medicaid fraud judgments.
- CA consistently ranks among the top states for total fraud dollars and volume of federal investigations. As a result, federal authorities have taken the unusual step of deferring portions of its state Medicaid reimbursements.
- In Illinois Dr. Daniel Robinson billed Medicare for $67 million for “counseling and therapy services.” According to prosecutors obviously, this was a fraudulently inflated amount since his company was not large enough to generate that size of a bill even if all the employees worked 24 hours a day.
- Historically, Florida has had a reputation for massive health care fraud schemes involving telemedicine, genetic testing, and durable medical equipment. In a particularly egregious case, a high school basketball player died during practice after his doctor had approved his cardiovascular test results as being normal even though the student had pre-existing cardiac issues and despite the fact that the doctor had only given the test results a “cursory glance.”
CONCLUSION
I believe that this story had been underreported by the mainstream media until yesterday. In my opinion, this was partly due to the attention being paid to the more dominant issues such as the war with Iran, the economy, and the upcoming midterm elections. Moreover, the initial story involved MN, which is a state controlled by Dems, and the perpetrators were largely Somali illegal immigrants. I am glad the DOJ made such a huge splash to bring this to the attention of the general public.
As I discussed above, this widespread fraud is unconscionable on its face. I’m glad that the DOJ is prosecuting the perpetrators. However, I think it should also prosecute the politicians who were responsible for supervising these people. Either they didn’t know about the schemes, which would constitute an abject failure of their duty to supervise, or they did know and aided, abetted and covered it up, which is just as bad.