US prosecutors have charged 15 people, including six medical professionals, in a group of Los Angeles healthcare-fraud cases involving more than $1.8 billion in allegedly false claims to government and private programmes.
The Justice Department announced the cases on October 22 after eight arrests. The largest allegation concerns more than $1.6 billion billed through a scheme that prosecutors say lured vulnerable people to California for sham substance-abuse treatment. The department described it as the largest prosecution of its kind.
Separate cases allege $134 million in Medicare billing for unnecessary atherectomy procedures that injured patients and more than $138 million in hospice claims for people who were not terminally ill. Another defendant was indicted in an alleged $270 million Medi-Cal pharmacy scheme involving prescriptions the government says were bogus.
The announcement combines distinct indictments and complaints rather than a single case or a final calculation of loss. The charged conduct, defendants and procedural posture vary. Some defendants were arrested on the day of the announcement; others had already been charged or were expected to appear in federal courts in California and Texas.
All of the allegations remain to be proved. Billing totals are not equivalent to adjudicated loss, and the presence of a medical professional among the defendants does not establish that the treatment or claim allegations are true. Each defendant is entitled to contest the charges, the government’s loss calculations and any patient-harm evidence in the relevant proceeding.
