U.S. Justice Department charges 15 in Los Angeles health care fraud crackdown

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Highlights

U.S. Department of Justice charged 15 defendants, including six medical professionals, linked to $1.8 billion in fraudulent health care claims in Los Angeles.
The largest case involves $1.6 billion in fraudulent sober home claims, while related schemes billed $134 million for unnecessary surgical procedures and $138 million for improper hospice care.
Separate $270 million Medi-Cal fraud and multiyear schemes reveal large-scale losses for Medicare, Medicaid, and private insurers, prompting coordinated enforcement and eight immediate arrests.

Charges span treatment, surgery and hospice schemes

As reported by the U.S. Department of Justice, citing the U.S. Department of Justice, 15 defendants, including six medical professionals, are charged in health care fraud schemes that collectively resulted in more than $1.8 billion in fraudulent claims to government and private insurance programs. The department says the largest case involves more than $1.6 billion billed through a scheme that allegedly lured vulnerable people to California for sham substance abuse treatment, which it describes as the biggest sober home fraud prosecution of its kind brought by the department.

Prosecutors also allege that defendants fraudulently billed $134 million to Medicare for unnecessary atherectomy procedures that injured patients. In three separate hospice matters, authorities say more than $138 million was billed to Medicare for patients who were not terminally ill.

In a separate case tied to California's Medicaid system, another defendant was indicted after previously being charged by complaint in an alleged $270 million Medi-Cal fraud scheme involving pharmacy claims for bogus prescriptions. Eight defendants were arrested today, with six expected to make initial appearances in downtown Los Angeles and two expected to appear in federal court in Texas.

Enforcement push highlights financial and patient risks

Justice Department and FBI officials say the prosecutions reflect both the scale of losses to taxpayer-funded programs and the harm caused to patients. Assistant Attorney General Colin M. McDonald says the cases include the department's largest sober home fraud scheme and an unnecessary invasive procedure case identified through data analytics.

FBI Director Kash Patel says investigators and partner agencies executed eight arrests while charging seven additional defendants in what authorities describe as a multiyear fraud operation affecting substance abuse treatment, hospice care and Medicare programs in the Los Angeles area. First Assistant U.S. Attorney Bill Essayli says the alleged conduct diverts money from private and public insurance systems, while FBI Los Angeles official Patrick Grandy says the bureau will continue working with law enforcement partners to protect government health care programs and taxpayers.

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