The U.S. Justice Department released
the below information:
Attorney General Jeff
Sessions and Department of Health and Human Services (HHS) Secretary Tom Price,
M.D., announced today the largest ever health care fraud enforcement action by
the Medicare Fraud Strike Force, involving 412 charged defendants across 41
federal districts, including 115 doctors, nurses and other licensed medical
professionals, for their alleged participation in health care fraud schemes
involving approximately $1.3 billion in false billings. Of those charged, over
120 defendants, including doctors, were charged for their roles in prescribing
and distributing opioids and other dangerous narcotics. Thirty state Medicaid
Fraud Control Units also participated in today’s arrests. In addition, HHS has
initiated suspension actions against 295 providers, including doctors, nurses
and pharmacists.
Attorney General Sessions and
Secretary Price were joined in the announcement by Acting Assistant Attorney
General Kenneth A. Blanco of the Justice Department’s Criminal Division, Acting
Director Andrew McCabe of the FBI, Acting Administrator Chuck Rosenberg of the
Drug Enforcement Administration (DEA), Inspector General Daniel Levinson of the
HHS Office of Inspector General (OIG), Chief Don Fort of IRS Criminal
Investigation, Administrator Seema Verma of the Centers for Medicare and
Medicaid Services (CMS), and Deputy Director Kelly P. Mayo of the Defense
Criminal Investigative Service (DCIS).
Today’s enforcement actions
were led and coordinated by the Criminal Division, Fraud Section’s Health Care
Fraud Unit in conjunction with its Medicare Fraud Strike Force (MFSF) partners,
a partnership between the Criminal Division, U.S. Attorney’s Offices, the FBI
and HHS-OIG. In addition, the operation
includes the participation of the DEA, DCIS, and State Medicaid Fraud Control
Units.
The charges announced today aggressively
target schemes billing Medicare, Medicaid, and TRICARE (a health insurance
program for members and veterans of the armed forces and their families) for
medically unnecessary prescription drugs and compounded medications that often
were never even purchased and/or distributed to beneficiaries. The charges also
involve individuals contributing to the opioid epidemic, with a particular
focus on medical professionals involved in the unlawful distribution of opioids
and other prescription narcotics, a particular focus for the Department.
According to the CDC, approximately 91 Americans die every day of an opioid
related overdose.
“Too many trusted medical
professionals like doctors, nurses, and pharmacists have chosen to violate
their oaths and put greed ahead of their patients,” said Attorney General
Sessions. “Amazingly, some have made their practices into multimillion dollar
criminal enterprises. They seem oblivious to the disastrous consequences of
their greed. Their actions not only enrich themselves often at the expense of
taxpayers but also feed addictions and cause addictions to start. The
consequences are real: emergency rooms, jail cells, futures lost, and
graveyards. While today is a historic
day, the Department's work is not finished. In fact, it is just beginning. We
will continue to find, arrest, prosecute, convict, and incarcerate fraudsters
and drug dealers wherever they are.”
“Healthcare fraud is not only
a criminal act that costs billions of taxpayer dollars - it is an affront to
all Americans who rely on our national healthcare programs for access to
critical healthcare services and a violation of trust,” said Secretary Price.
“The United States is home to the world’s best medical professionals, but their
ability to provide affordable, high-quality care to their patients is
jeopardized every time a criminal commits healthcare fraud. That is why this
Administration is committed to bringing these criminals to justice, as
President Trump demonstrated in his 2017 budget request calling for a new $70
million investment in the Health Care Fraud and Abuse Control Program. The
historic results of this year’s national takedown represent significant
progress toward protecting the integrity and sustainability of Medicare and
Medicaid, which we will continue to build upon in the years to come.”
According to court documents,
the defendants allegedly participated in schemes to submit claims to Medicare,
Medicaid and TRICARE for treatments that were medically unnecessary and often
never provided. In many cases, patient recruiters, beneficiaries and other
co-conspirators were allegedly paid cash kickbacks in return for supplying
beneficiary information to providers, so that the providers could then submit
fraudulent bills to Medicare for services that were medically unnecessary or
never performed. The number of medical professionals charged is particularly
significant, because virtually every health care fraud scheme requires a
corrupt medical professional to be involved in order for Medicare or Medicaid
to pay the fraudulent claims.
Aggressively pursuing corrupt medical professionals not only has a
deterrent effect on other medical professionals, but also ensures that their
licenses can no longer be used to bilk the system.
“This week, thanks to the
work of dedicated investigators and analysts, we arrested once-trusted doctors,
pharmacists and other medical professionals who were corrupted by greed,” said
Acting Director McCabe. “The FBI is committed to working with our partners on
the front lines of the fight against heath care fraud to stop those who steal
from the government and deceive the American public.”
“Health care fraud is a
reprehensible crime. It not only
represents a theft from taxpayers who fund these vital programs, but impacts
the millions of Americans who rely on Medicare and Medicaid,” said Inspector
General Levinson. “In the worst fraud cases, greed overpowers care, putting
patients’ health at risk. OIG will continue to play a vital leadership role in
the Medicare Fraud Strike Force to track down those who abuse important federal
health care programs.”
“Our enforcement actions
underscore the commitment of the Defense Criminal Investigative Service and our
partners to vigorously investigate fraud perpetrated against the DoD's TRICARE
Program. We will continue to relentlessly investigate health care fraud, ensure
the taxpayers' health care dollars are properly spent, and endeavor to
guarantee our service members, military retirees, and their dependents receive
the high standard of care they deserve,” advised Deputy Director Mayo.
“Last year, an estimated
59,000 Americans died from a drug overdose, many linked to the misuse of
prescription drugs. This is, quite simply, an epidemic,” said Acting
Administrator Rosenberg. “There is a great responsibility that goes along with
handling controlled prescription drugs, and DEA and its partners remain
absolutely committed to fighting the opioid epidemic using all the tools at our
disposal.”
“Every defendant in today’s
announcement shares one common trait - greed,” said Chief Fort. “The desire for
money and material items drove these individuals to perpetrate crimes against
our healthcare system and prey upon many of the vulnerable in our society. Thanks to the financial expertise and
diligence of IRS-CI special agents, who worked side-by-side with other federal,
state and local law enforcement officers to uncover these schemes, these
criminals are off the street and will now face the consequences of their
actions.”
The Medicare Fraud Strike Force
operations are part of a joint initiative between the Department of Justice and
HHS to focus their efforts to prevent and deter fraud and enforce current
anti-fraud laws around the country. The Medicare Fraud Strike Force operates in
nine locations nationwide. Since its inception in March 2007, the Medicare
Fraud Strike Force has charged over 3500 defendants who collectively have
falsely billed the Medicare program for over $12.5 billion.
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For the Strike Force
locations, in the Southern District of Florida, a total of 77 defendants were
charged with offenses relating to their participation in various fraud schemes
involving over $141 million in false billings for services including home
health care, mental health services and pharmacy fraud. In one case, the owner and operator of a
purported addiction treatment center and home for recovering addicts and one
other individual were charged in a scheme involving the submission of over $58
million in fraudulent medical insurance claims for purported drug treatment
services. The allegations include actively recruiting addicted patients to move
to South Florida so that the co-conspirators could bill insurance companies for
fraudulent treatment and testing, in return for which, the co-conspirators offered
kickbacks to patients in the form of gift cards, free airline travel, trips to
casinos and strip clubs, and drugs.
In the Eastern District of
Michigan, 32 defendants face charges for their alleged roles in fraud,
kickback, money laundering and drug diversion schemes involving approximately
$218 million in false claims for services that were medically unnecessary or never
rendered. In one case, nine defendants, including six physicians, were charged
with prescribing medically unnecessary controlled substances, some of which
were sold on the street, and billing Medicare for $164 million in facet joint
injections, drug testing, and other procedures that were medically unnecessary
and/or not provided.
In the Southern District of
Texas, 26 individuals were charged in cases involving over $66 million in
alleged fraud. Among these defendants are a physician and a clinic owner who
were indicted on one count of conspiracy to distribute and dispense controlled
substances and three substantive counts of distribution of controlled
substances in connection with a purported pain management clinic that is
alleged to have been the highest prescribing hydrocodone clinic in Houston,
where approximately 60-70 people were seen daily, and were issued medically
unnecessary prescriptions for hydrocodone in exchange for approximately $300
cash per visit.
In the Central District of
California, 17 defendants were charged for their roles in schemes to defraud
Medicare out of approximately $147 million. Two of these defendants were
indicted for their alleged involvement in a $41.5 million scheme to defraud
Medicare and a private insurer. This was purportedly done by submitting
fraudulent claims, and receiving payments for, prescription drugs that were not
filled by the pharmacy nor given to patients.
In the Northern District of
Illinois, 15 individuals were charged in cases related to six different schemes
concerning home health care services and physical therapy fraud, kickbacks, and
mail and wire fraud. These schemes
involved allegedly over $12.7 million in fraudulent billing. One case allegedly
involved $7 million in fraudulent billing to Medicare for home health services
that were not necessary nor rendered.
In the Middle District of
Florida, 10 individuals were charged with participating in a variety of schemes
involving almost $14 million in fraudulent billing. In one case, three defendants were charged in
a $4 million scheme to defraud the TRICARE program. In that case, it is alleged that a defendant
falsely represented himself to be a retired Lieutenant Commander of the United
States Navy Submarine Service. It is alleged that he did so in order to gain
the trust and personal identifying information from TRICARE beneficiaries, many
of whom were members and veterans of the armed forces, for use in the scheme.
In the Eastern District of
New York, ten individuals were charged with participating in a variety of
schemes including kickbacks, services not rendered, and money laundering
involving over $151 million in fraudulent billings to Medicare and Medicaid.
Approximately $100 million of those fraudulent billings were allegedly part of
a scheme in which five health care professionals paid illegal kickbacks in
exchange for patient referrals to their own clinics.
In the Southern Louisiana
Strike Force, operating in the Middle and Eastern Districts of Louisiana as
well as the Southern District of Mississippi, seven defendants were charged in
connection with health care fraud, wire fraud, and kickback schemes involving
more than $207 million in fraudulent billing. One case involved a pharmacist
who was charged with submitting and causing the submission of $192 million in
false and fraudulent claims to TRICARE and other health care benefit programs
for dispensing compounded medications that were not medically necessary and
often based on prescriptions induced by illegal kickback payments.
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In addition to the Strike
Force locations, today’s enforcement actions include cases and investigations
brought by an additional 31 U.S. Attorney’s Offices, including the execution of
search warrants in investigations conducted by the Eastern District of California
and the Northern District of Ohio.
In the Northern and Southern
Districts of Alabama, three defendants were charged for their roles in two
health care fraud schemes involving pharmacy fraud and drug diversion.
In the Eastern District of
Arkansas, 24 defendants were charged for their roles in three drug diversion
schemes that were all investigated by the DEA.
In the Northern and Southern
Districts of California, four defendants, including a physician, were charged
for their roles in a drug diversion scheme and a health care fraud scheme
involving kickbacks.
In the District of
Connecticut, three defendants were charged in two health care fraud schemes,
including a scheme involving two physicians who fraudulently billed Medicaid
for services that were not rendered and for the provision of oxycodone with
knowledge that the prescriptions were not medically necessary.
In the Northern and Southern
Districts of Georgia, three defendants were charged in two health care fraud
schemes involving nearly $1.5 million in fraudulent billing.
In the Southern District of
Illinois, five defendants were charged in five separate schemes to defraud the
Medicaid program.
In the Northern and Southern
Districts of Indiana, at least five defendants were charged in various health
care fraud schemes related to the unlawful distribution and dispensing of
controlled substances, kickbacks, and services not rendered.
In the Southern District of
Iowa, five defendants were charged in two schemes involving the distribution of
opioids.
In the Western District of
Kentucky, 11 defendants were charged with defrauding the Medicaid program. In one case, four defendants, including three
medical professionals, were charged with distributing controlled substances and
fraudulently billing the Medicaid program.
In the District of Maine, an
office manager was charged with embezzling funds from a medical office.
In the Eastern and Western
Districts of Missouri, 16 defendants were charged in schemes involving over $16
million in claims, including 10 defendants charged as part of a scheme
involving fraudulent lab testing.
In the District of Nebraska,
a dentist was charged with defrauding the Medicaid program.
In the District of Nevada,
two defendants, including a physician, were charged in a scheme involving false
hospice claims.
In the Northern, Southern,
and Western Districts of New York, five defendants, including two physicians
and two pharmacists, were charged in schemes involving drug diversion and
pharmacy fraud.
In the Southern District of
Ohio, five defendants, including four physicians, were charged in connection
with schemes involving $12 million in claims to the Medicaid program.
In the District of Puerto
Rico, 13 defendants, including three physicians and two pharmacists, were
charged in four schemes involving drug diversion, Medicaid fraud, and the theft
of funds from a health care program.
In the Eastern District of
Tennessee, three defendants were charged in a scheme involving fraudulent
billings and the distribution of opioids.
In the Eastern, Northern, and
Western Districts of Texas, nine defendants were charged in schemes involving
over $42 million in fraudulent billing, including a scheme involving false
claims for compounded medications.
In the District of Utah, a
nurse practitioner was charged in connection with fraudulently obtaining a
controlled substance, tampering with a consumer product, and infecting over
seven individuals with Hepatitis C.
In the Eastern District of
Virginia, a defendant was charged in connection with a scheme involving
identify theft and fraudulent billings to the Medicaid program.
In addition, in the states of
Arizona, Arkansas, California, Delaware, Illinois, Iowa, Louisiana,
Massachusetts, Michigan, Minnesota, Mississippi, New York, Oklahoma,
Pennsylvania, Rhode Island, South Dakota, Texas, Utah, Vermont, Washington and
Wisconsin, 96 defendants have been charged in criminal and civil actions with
defrauding the Medicaid program out of over $31 million. These cases were
investigated by each state’s respective Medicaid Fraud Control Units. In
addition, the Medicaid Fraud Control Units of the states of Alabama, Florida,
Georgia, Illinois, Indiana, Iowa, Kansas, Kentucky, Missouri, Nebraska, New
York, North Carolina, Ohio, Texas, and Utah participated in the investigation
of many of the federal cases discussed above.
The cases announced today are
being prosecuted and investigated by U.S. Attorney’s Offices nationwide, along
with Medicare Fraud Strike Force teams from the Criminal Division’s Fraud
Section and from the U.S. Attorney’s Offices of the Southern District of
Florida, Eastern District of Michigan, Eastern District of New York, Southern
District of Texas, Central District of California, Eastern District of
Louisiana, Northern District of Texas, Northern District of Illinois and the
Middle District of Florida; and agents from the FBI, HHS-OIG, Drug Enforcement
Administration, DCIS and state Medicaid Fraud Control Units.
A complaint, information, or
indictment is merely an allegation, and all defendants are presumed innocent
unless and until proven guilty.
Additional documents related
to this announcement will shortly be available here:
https://www.justice.gov/opa/documents-and-resources-july-13-2017.
This operation also
highlights the great work being done by the Department of Justice’s Civil
Division. In the past fiscal year, the
Department of Justice, including the Civil Division, has collectively won or
negotiated over $2.5 billion in judgements and settlements related to matters
alleging health care fraud.
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