Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Policy and Regulation News

DOJ Nabs 601 Defendants in Biggest Healthcare Fraud Takedown Yet

The US’s largest healthcare fraud takedown charged 601 healthcare professionals for $2 billion of improper payments within Medicare, Medicaid, and other federal healthcare programs.

DoJ charges 601 individuals for $2 billion in healthcare fraud.

Source: Thinkstock

By Thomas Beaton

- HHS Secretary Alex Azar and Attorney General Jeff Sessions have announced the largest healthcare fraud takedown yet after HHS, the Department of Justice (DOJ), and other law enforcement agencies charged 601 healthcare professionals for $2 billion in fraudulent activities.

Nearly 165 providers and co-conspirators have been charged with billing Medicare, Medicaid, TRICARE, and other federal healthcare programs for unnecessary or fraudulent opioid prescriptions.

The DOJ led 38 Medicaid Fraud Control Units (MFCUs), the Office of the Inspector General (OIG), the FBI, DEA, and over 1000 officers from law enforcement agencies in pursuing charges and other fraud enforcement actions.

Sessions praised the ability of federal agencies to cooperate in order to prevent federal losses and address national public health concerns related to opioid safety and abuse.

“Health care fraud is a betrayal of vulnerable patients, and often it is theft from the taxpayer,” Sessions said. “In many cases, doctors, nurses, and pharmacists take advantage of people suffering from drug addiction in order to line their pockets. These are despicable crimes. That’s why this Department of Justice has taken historic new steps to go after fraudsters, including hiring more prosecutors and leveraging the power of data analytics.”

“Today the Department of Justice is announcing the largest health care fraud enforcement action in American history,” Sessions continued. “This is the most fraud, the most defendants, and the most doctors ever charged in a single operation—and we have evidence that our ongoing work has stopped or prevented billions of dollars’ worth of fraud.”

Many of the providers and professionals are charged with engaging in kickback schemes by offering cash incentives to patient recruiters, beneficiaries, and other co-conspirators in return for information about beneficiaries. The providers allegedly used this information to overprescribe opioid-based medications and submit fraudulent bills to federal healthcare programs.

The scope of the DOJ’s investigation is immense. Fraud enforcement agencies have pressed criminal charges in over 35 states.

In one case, 33 individuals in Southern California were charged with bilking federal and private payers out of $660 million through pharmacy compounding schemes.

“[The] fraud case alleges an attorney/marketer paid kickbacks and offered incentives such as prostitutes and expensive meals to two podiatrists in exchange for prescriptions written on pre-printed prescription pads, regardless of the medical need for the prescriptions,” the DoJ said.

“Once the prescriptions were filled, members of the conspiracy submitted approximately $250 million in fraudulent claims to federal, state, and private insurers for the compounded drugs.”

Federal officials believe that the criminal charges will help deter future criminal activity related to healthcare fraud and ensure beneficiaries are protected from patient safety risks associated with these crimes.

“This year’s operations, focusing on opioid-related schemes, spotlight the far-reaching impact of health care fraud,” said HHS Deputy Inspector General Gary L. Cantrell.  

“Such crimes threaten the vitally important Medicare and Medicaid programs and the beneficiaries they serve. Though we have made significant progress in our fight against health care fraud; our efforts are not complete. We will continue to work with our partners to protect the health and safety of millions of Americans.”

The DoJ’s actions follow the recent development of CMS initiatives to deter fraud within large federal healthcare programs.

Days before the charges were pressed, CMS announced new Medicaid program integrity initiatives aimed at preventing improper payments at both the federal and state level. In addition, a group of US Senators representing the Senate Budget Committee urged HHS to address billions in improper payments within Medicaid and Medicare.

The actions show a continuation of federal enforcement agencies’ aggressive crackdown on healthcare fraud, which has already led to the recovery of  $1.8 billion in Medicaid losses.


Sign up for our free newsletter:

Our privacy policy

no, thanks

Continue to site...