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Analysis

More Than 600 Charged in 'Largest Healthcare Fraud Takedown in History'

By Steven Porter  
   June 28, 2018

The DOJ and HHS announced what officials described as a record-breaking enforcement action in a joint press conference.

More than 600 people—including 76 doctors, 23 pharmacists, 19 nurses, and other medical personnel—have been charged in what U.S. Attorney General Jeff Sessions called "the largest healthcare fraud takedown" in history.

Sessions announced the charges Thursday alongside Health and Human Services Secretary Alex Azar and other federal officials in a joint press conference outlining more than $2 billion in alleged fraud, much of it related to the opioid crisis.

"One of the alleged criminals charged today used his position at a recovery center to prescribe controlled substances without a license while the center worked in tandem with other treatment centers to bilk those who were trying to enter recovery," Azar said.

"Beyond the opioid epidemic, a number of other cases involved alleged kickback schemes between providers to take advantage of Medicare beneficiaries. In one case, patient recruiters were allegedly paid an exchange for the referral of fraudulent prescriptions," Azar said.

"The perpetrators really are despicable and greedy people," he added.

Many of the major cases were investigated by the Medicare Fraud Strike Force, which is a joint venture between the DOJ and HHS:

  • Southern District of Florida: 124 people were charged in connection with more than $337 million in alleged false billings for services, including home health and pharmacy fraud, according to the DOJ.
     
  • Central District of California: 33 people were charged in connection with $660 million in alleged fraud, including one case in which an attorney allegedly offered expensive meals and prostitutes to two podiatrists in exchange for prescriptions on pre-printed prescription pads.
     
  • Southern District of Texas: 48 people, including a pharmacy chain owner, managing partner, and lead pharmacist, were charged in connection with more than $291 million in alleged fraud.
     
  • Eastern District of Michigan: 35 people were charged in connection with $197 million in alleged false claims for medical services that were either unnecessary or never provided.
     
  • Northern District of Illinois: 21 people were charged in connection with more than $54 million in allegedly fraudulent billing, including one major case of alleged kickbacks and home health fraud.
     
  • Eastern District of New York: 13 people were charged in connection with more than $38 million in allegeldy fraudulent billing, including one case in which an ambulette company allegedly conspired in illegal patient referrals.
     
  • Middle District of Florida: 13 people were charged in connection with more than $21 million in allegedly fraudulen tbilling, including one case in which a physician and clinic owner allegedly defrauded Medicare of more than $2.8 million in home healthcare.
     
  • Middle and Eastern Districts of Louisiana and Southern District of Mississippi: 42 people were charged in connection with more than $16 million in allegedly fraudulent billings, including drug diversion and money laundering schemes.
     
  • Middle District of Tennessee: 5 people were charged with million-dollar kickback conspiracy at a durable medical equipment company allegedly involving more than $2.5 million in fraudulent Medicare bills.

In addition to the Strike Force operations, the DOJ pointed to enforcement actions taken by 46 U.S. attorneys as part of Thursday's announcement.

The officials said Thursday's announcement surpasses the previous record, set last July, when more than 400 defendants were charged. Since then, the HHS Office of Inspector General has issued exclusion notices to 587 doctors, nurses, and other providers as a result of their behavior related to opioid abuse and diversion.

Steven Porter is editor at HealthLeaders.

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