California: The US Department of Justice (DOJ) has charged 15 people, including six medical professionals, over alleged healthcare fraud schemes involving approximately $2 billion in claims submitted to public and private insurers in California.
Announced on October 22, the cases include a $1.6 billion alleged substance abuse treatment fraud, $135 million in unnecessary medical procedures and fraudulent hospice claims exceeding $138 million.
Federal prosecutors allege that Nathan Young, 39, and his father, David Young, 71, operated rehabilitation facilities that attracted patients from across the country with offers of free travel, accommodation and access to drugs. Patients were allegedly shifted between facilities while insurers were billed for treatment that was unnecessary or never provided. Four defendants face charges connected to the scheme, while another individual has pleaded guilty.
In a separate case, cardiothoracic surgeon Harold Tabaie, 78, and chiropractor Hany Malek, 61, were accused of performing unnecessary artery-clearing procedures. Prosecutors allege the treatments caused severe pain in some patients and generated about $135 million in Medicare claims.
Authorities also charged individuals accused of enrolling beneficiaries who were not terminally ill in hospice programmes. One defendant allegedly controlled multiple hospices that billed more than $107 million, while other cases involved false medical certifications and payments for patient referrals.
Additional allegations include fraudulent prescription claims, medically unnecessary genetic testing and kickbacks involving rehabilitation referrals. One case concerns an alleged $270 million scheme targeting California’s Medi-Cal programme.
Eight defendants were arrested on October 22, with others expected to appear in court in multiple locations.
Federal prosecutors described the operation as one of California’s largest recent healthcare fraud enforcement actions. Bill Essayli, first assistant US attorney in California, warned that authorities would pursue individuals who misuse healthcare funds or endanger patients.
The charges remain allegations, and defendants are presumed innocent unless proven guilty in court.
