Feds nab 6 providers in $2B healthcare fraud takedown

The Department of Justice announced on Thursday a large healthcare fraud takedown in California, resulting in alleged losses of $2 billion.

Fifteen people have been charged in schemes that resulted in fraudulent claims submitted to the government and private healthcare programs, including six medical professionals, according to the Justice Department.

The providers included Dr. Harold Tabaie of Anaheim, a cardiothoracic surgeon accused of billing Medicare $135 million for medically unnecessary arterial procedures with his business partner, chiropractor Hany Malek. Dr. Richard Keech of Torrance, California was also charged in connection with a $10 million plot involving false and fraudulent claims for unnecessary hospice services.

Healthcare fraud takedowns are coordinated national and regional enforcement efforts that often involve the Justice Department, HHS' Office of the Inspector General and the FBI. They are among the most aggressive federal enforcement actions the government takes against months- or years-long cases of healthcare fraud, waste and abuse.

Hospice has been a hotbed of fraudulent activity in healthcare, with many ploys targeting vulnerable, older populations. The takedown in California alone included more than $138 million in bogus bills to Medicare across three separate hospice schemes in which many patients were reportedly not terminally ill.

However, the Justice Department called out the latest fraud sweep for stopping the largest substance abuse treatment scheme ever prosecuted by the government. The plan involved luring people, including people without homes or living in poverty, to California for unnecessary or sham services that they then billed to private payers to the tune of $1.6 billion.

The Department explained that the accused -- Nathan and David Young of LA -- directed "body brokers" who illegally buy and sell individuals seeking treatment for substance use disorders. These people typically have private health insurance, which conspirators bill at premium prices. They also commonly target unhoused individuals and falsify coverage, particularly zero-premium Affordable Care Act plans.

The Youngs reportedly provided luxurious conditions, such as expensive hotels and private apartments, for those with private coverage while leaving those without top-tier coverage in unsanitary environments.

Additionally, the Justice Department nabbed the alleged perpetrators of a $270 million scheme to defraud Medi-Cal, California's Medicaid program, by submitting pharmacy claims for medically unnecessary prescriptions.

Under this scheme, Christina Mareik of Whittier, California allegedly took advantage of Medi-Cali's suspension of prior authorizations for certain drugs as the program transitioned to a new payment system. Mariek was previously charged in a similar healthcare fraud scheme last year.