DOJ charges 15 in Los Angeles health care fraud takedown over $1.8bn in claims
The Justice Department's new National Fraud Enforcement Division unveiled a coordinated Los Angeles takedown spanning sober home, hospice, atherectomy, genetic testing and pharmacy fraud. For compliance leads at insurers and providers, the sweep shows how data analytics now drives case selection and how kickback-driven patient recruitment remains the common thread across schemes totalling over $1.8 billion in fraudulent claims.
- Nathan Young, David Young, Honey Phipps and Cody Phipps are charged over a scheme that billed private insurers more than $1.6 billion for sham substance abuse treatment, with co-defendant Nicholas Moore pleading guilty to assisting $199 million in fraudulent claims.
- Dr. Harold Tabaie and Hany Malek face a $135 million Medicare scheme for unnecessary atherectomies, a case DOJ says was identified through data analytics showing Tabaie as an extreme national billing outlier from 2016 through 2023.
- Three separate hospice schemes, charged against Geoffrey Jimenez, Dr. Richard Keech and Armani Raffi, allegedly billed Medicare over $138 million for patients who were not terminally ill, with non-death discharge rates far above the national average.
- Christina Mareik was indicted over a nearly $270 million Medi-Cal pharmacy scheme exploiting the suspension of prior-authorization requirements, with approximately $269,130,000 billed and at least approximately $178,746,000 paid.
- Doctors Hassan Badday and Robby Ayoub are charged with accepting per-patient kickbacks from a marketer for ApolloMDx laboratory in exchange for authorizing medically unnecessary genetic testing orders.