The U.S. Justice Department released the below information:
Attorney General Jeff Sessions and Department of Health and
Human Services (HHS) Secretary Alex M. Azar III, announced today the largest
ever health care fraud enforcement action involving 601 charged defendants
across 58 federal districts, including 165 doctors, nurses and other licensed
medical professionals, for their alleged participation in health care fraud
schemes involving more than $2 billion in false billings. Of those charged, 162 defendants, including
76 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 announced today
that from July 2017 to the present, it has excluded 2,700 individuals from
participation in Medicare, Medicaid, and all other Federal health care
programs, which includes 587 providers excluded for conduct related to opioid
diversion and abuse.
Attorney General Sessions and Secretary Azar were joined in
the announcement by Acting Assistant Attorney General John P. Cronan of the
Justice Department’s Criminal Division, Deputy Director David L. Bowdich of the
FBI, Assistant Administrator John Martin of the Drug Enforcement Administration
(DEA), Deputy Inspector General Gary Cantrell of the HHS Office of Inspector
General (OIG), Deputy Chief Eric Hylton of IRS Criminal Investigation (CI),
Centers for Medicare and Medicaid Services (CMS) Deputy Administrator and
Director of the Center for Program Integrity Alec Alexander and Director Dermot
F. O’Reilly 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, IRS-CI, Department of Labor, other various
federal law enforcement agencies, and State Medicaid Fraud Control Units.
The charges announced today aggressively target schemes
billing Medicare, Medicaid, TRICARE (a health insurance program for members and
veterans of the armed forces and their families), and private insurance
companies 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 115 Americans
die every day of an opioid-related overdose.
“Health care fraud is a betrayal of vulnerable patients, and
often it is theft from the taxpayer,” said Attorney General Sessions. “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. 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. I want to thank our fabulous partners with
the FBI, DEA, our Health Care Fraud task forces, HHS, the Defense Criminal
Investigative Service, IRS Criminal Investigation, Medicare, and especially the
more than 1,000 federal, state, local, and tribal law enforcement officers from
across America who made this possible. By every measure we are more effective
at finding and prosecuting medical fraud than ever.”
“Every dollar recovered in this year’s operation represents
not just a taxpayer’s hard-earned money—it’s a dollar that can go toward
providing healthcare for Americans in need,” said HHS Secretary Azar. “This year’s Takedown Day is a significant
accomplishment for the American people, and every public servant involved
should be proud of their work.”
According to court documents, the defendants allegedly
participated in schemes to submit claims to Medicare, Medicaid, TRICARE, and
private insurance companies 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. Collectively, the doctors, nurses, licensed
medical professionals, health care company owners and others charged are
accused of submitting a total of over $2 billion in fraudulent billings. 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.
“Healthcare fraud touches every corner of the United States
and not only costs taxpayers money, but also can have deadly consequences,”
said FBI Deputy Director Bowdich.
“Through investigations across the country, we have seen medical
professionals putting greed above their patients’ well-being and trusted doctors
fanning the flames of the opioid crisis.
I want to thank the agents, analysts and our law enforcement partners in
every field office who work each and every day to stop these criminals and hold
them accountable for their actions.”
“DEA is committed to ending the opioid crisis occurring in our
communities and preventing prescription drug misuse,” said DEA Assistant
Administrator Martin. “DEA will continue
to work with our partners every day to protect our citizens while ensuring that
patients have adequate access to these critical medications.”
“This year’s operations, focusing on opioid-related schemes,
spotlight the far-reaching impact of health care fraud,” said HHS Deputy
Inspector General 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.”
“It takes a special kind of person to prey on the sick and
vulnerable as happened in many of these health care fraud schemes,” said Deputy
Chief Hylton. “Medical professionals and
others callously placed individuals and vital healthcare services in harm’s way
simply because of greed. IRS-CI special
agents continue to work side-by-side with other federal, state and local law
enforcement officers to uncover these schemes and hold these criminals
accountable for their actions.”
“CMS makes it a top priority to protect the health and
safety of millions of beneficiaries who depend on vital federal healthcare
programs,” said Alec Alexander, deputy administrator and director of the Center
for Program Integrity. “CMS’ Center for
Program Integrity collaborates closely with our law enforcement partners to
safeguard precious taxpayer dollars. Under Administrator Seema Verma, we will
continue to strengthen this partnership with law enforcement in order to ensure
the integrity and sustainability of these essential programs that serve millions
of Americans.”
“Heath care fraud wounds our service members and veterans
alike, as they rely upon and rightfully expect uncompromised care through the
Department of Defense’s TRICARE Program,” said DCIS Director O’Reilly. “Investigations that culminated in
enforcement actions over the past several days underscore the steadfast
commitment of the Defense Criminal Investigative Service and our investigative
partners to vigorously investigate fraud impacting TRICARE. We remain vigilant in our efforts to ensure
the high standards of care our service members, military retirees, and their
dependents deserve while safeguarding American taxpayer dollars.”
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 10 locations nationwide.
Since its inception in March 2007, the Medicare Fraud Strike Force has
charged over 3,700 defendants who collectively have falsely billed the Medicare
program for over $14 billion.
*********
For the Strike Force locations, in the Southern District of
Florida, 124 defendants were charged with offenses relating to their
participation in various fraud schemes involving over $337 million in false
billings for services including home health care and pharmacy fraud. In one case, an owner, medical director, and
two employees of a sober living facility were charged with conspiracy to commit
health care and wire fraud, substantive counts of health care fraud, and
substantive counts of money laundering.
The indictment alleges a scheme that illegally recruited patients, paid
kickbacks, and defrauded health care benefit programs for widespread fraudulent
urine testing. During the course of the
fraudulent scheme, the facility submitted more than $106 million in claims for
substance abuse treatment services.
In the Central District of California, 33 defendants were
charged for their roles in schemes to defraud insurance programs out of more
than $660 million. For example, one
indictment in a compounding pharmacy 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. 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.
In the Southern District of Texas, 48 individuals were
charged in cases involving more than $291 million in alleged fraud. Among these defendants are a pharmacy chain
owner, managing partner, and lead pharmacist charged with a drug and money
laundering conspiracy. According to the indictment, the coconspirators used
fraudulent prescriptions to fill bulk orders for over one million pills of
hydrocodone and oxycodone, which the pharmacy, in turn, sold to drug couriers
for millions of dollars. In the Northern
District of Texas, a home health agency owner was arrested on a criminal
complaint for a $2.6 million health care fraud scheme.
In the Eastern District of Michigan, 35 defendants face
charges for their alleged roles in fraud, kickback, money laundering and drug
diversion schemes involving approximately $197 million in false claims for
services that were medically unnecessary or never rendered. In one case, a physician was charged in
separate kickback conspiracies with two home health agency owners, which
resulted in more than $12 million in fraudulent insurance billings.
In the Northern District of Illinois, 21 individuals were
charged for various fraud schemes involving home health and dental
services. These schemes involved
allegedly over $54 million in fraudulent billing. One case alleges a home health fraud and
kickback conspiracy, which resulted in more than $6.2 million paid by Medicare
based on the fraudulent billings.
In the Eastern District of New York, 13 individuals were
charged with participating in a variety of schemes including kickbacks,
services not rendered, identity theft and money laundering involving over $38
million in fraudulent billings. For
example, the owner of a Brooklyn ambulette company was charged in a $7 million
conspiracy stemming from the alleged payment of kickbacks for the referral of
patients, who subjected themselves to purported physical and occupational
therapy and other services, and were transported by the ambulette company.
In the Middle District of Florida, 21 individuals were
charged with participating in a variety of schemes involving more than $21
million in fraudulent billings. In one
case, a physician and clinic owner were charged with a conspiracy to defraud
Medicare of more than $2.8 million for fraudulent home health billings.
In the Southern Louisiana Strike Force, operating in the
Middle and Eastern Districts of Louisiana as well as the Southern District of
Mississippi, 42 defendants were charged in connection with health care fraud,
drug diversion, and money laundering schemes involving more than $16 million in
fraudulent billings. One case alleges
that three pharmacy owners and a nurse practitioner conspired to unlawfully
dispense controlled substances and defraud TRICARE and private insurance
companies out of $12 million.
In the Corporate Strike Force, five defendants were charged
in the Middle District of Tennessee with a kickback conspiracy at a durable
medical equipment company, which allegedly resulted in more than $1 million in
kickbacks and over $2.5 million in fraudulent billings to Medicare.
*********
In addition to the Strike Force locations, today’s
enforcement actions include cases and investigations brought by an additional
46 U.S. Attorney’s Offices, including the execution of search warrants in various investigations
conducted by the Central and Northern Districts of California, Middle District
of Florida, Southern District of Georgia, Western District of Kentucky, Eastern
District of Michigan, Western District of North Carolina, Eastern and Western
Districts of Texas, Eastern and Western Districts of Virginia, and Western
District of Washington.
In the Northern and Southern Districts of Alabama, 15
defendants were charged for their roles in eight health care fraud schemes
involving compounding pharmacy fraud and unlawful distribution of controlled
substances.
In the Eastern District of California, four defendants were
charged for their roles in two health care fraud schemes, one of which included
forged prescriptions.
In the Southern District of California, seven defendants,
including a physician, were charged for their roles in three health care fraud
schemes and one scheme involving identity theft and services that were not
rendered.
In the District of Colorado, a defendant was charged with
health care fraud related to billings to Medicaid and Medicare.
In the District of Connecticut, three defendants, including
two medical professionals, were charged for their roles in two schemes
involving compounding drugs and unlawful distribution of Schedule II and IV
controlled substances.
In the District of Delaware, a physician/owner of a pain
management clinic was charged with unlawfully prescribing more than two million
dosage units of Oxycodone products.
In the District of Columbia, a durable medical equipment
company owner was charged with defrauding Medicaid of $9.8 million.
In the Northern District of Florida, four defendants were
charged in a scheme to defraud TRICARE and other private insurance companies
out of over $8 million for medically unnecessary compounded creams and pills.
In the Northern, Middle, and Southern Districts of Georgia,
12 defendants, including two physicians, were charged in nine health care
fraud, drug diversion, or compounding pharmacy schemes involving over $13.5
million in fraudulent billings.
In the District of Idaho, three defendants, all of who are
medical professionals, were charged for their roles in three separate fraud
schemes involving controlled substances.
In the Central and Southern Districts of Illinois, seven
defendants were charged in six separate schemes to defraud the Medicaid
program.
In the Northern District of Indiana, eight defendants were
charged in various health care fraud schemes to defraud both the Medicare and
Medicaid programs.
In the Northern District of Iowa, two defendants – both
medical professionals – were charged for their roles in two opioid-related
schemes.
In the Districts of Kansas and the Northern and Western
Districts of Oklahoma, 12 defendants, including four physicians, were charged
in various unlawful distribution of controlled substances schemes. In the Western District of Oklahoma, one case
marks the district’s first time charging unlawful distribution of controlled
substances resulting in a death.
In the Eastern and Western Districts of Kentucky, 12
defendants, including five medical professionals, were charged in various
schemes involving health care fraud, unlawful distribution of controlled
substances, aggravated identity theft, and money laundering. One case involved the operation of two
false-front medical clinics.
In the Districts of Maine and Vermont, two defendants were
charged for their roles in two schemes to defraud various government programs
including Medicare, Medicaid, and ones run by the HHS’ Administration for
Children and Families.
In the District of Nebraska, seven defendants, including one
physician, were charged in five separate schemes to defraud Medicare, Medicaid,
and various HHS programs.
In the District of Nevada, four defendants, including three
medical professionals were charged with conspiracies to commit health care
fraud and distribute controlled substances.
In the District of New Jersey, eight defendants, including a
New York doctor, an anesthesiology technologist for a Philadelphia hospital,
and the owner of a medical billing company, were charged for their roles in
five schemes to defraud private insurance companies of over $16 million.
In the Southern District of New York, two defendants were
charged in schemes involving health care fraud or drug diversion.
In the Middle District of North Carolina, two defendants
were charged with a conspiracy to defraud Medicare out of over $4 million.
In the Southern District of Ohio, three defendants – all
medical professionals – were charged for their roles in two health care fraud
schemes, one of which involved illegal drug distribution and kickbacks.
In the Eastern and Middle Districts of Pennsylvania, 12
defendants were charged for their roles in three drug diversion schemes.
In the Western District of Pennsylvania, four defendants –
all physicians – were charged in various health care fraud and drug diversion
schemes. One scheme involved 32,000 dosage units of buprenorphine.
In the District of Rhode Island, one defendant was charged
for participating in a theft and aggravated identity theft scheme.
In the District of South Carolina, three defendants were
charged for their separate roles in a conspiracy to possess with the intent to
distribute fentanyl.
In the District of South Dakota, two defendants were charged
in separate cases, one of which involved a scheme to defraud the Indian Health
Service.
In the Middle District of Tennessee, 10 defendants were
charged in two separate schemes, including a conspiracy to fraudulently obtain
oxycodone.
In the Eastern District of Texas, two defendants were
charged for their role in health care fraud schemes to defraud the Medicare and
Medicaid programs.
In the District of Utah, two defendants were charged in two
cases, one of which involved a $31 million scheme to defraud Medicare and
Medicaid.
In the Western District of Virginia, eight defendants were
charged for their alleged roles in health care fraud schemes. One $45 million scheme to defraud Medicaid
involved falsification of documents in patient files.
In the Eastern District of Washington, a dentist and another
individual were indicted for distributing and conspiring to distribute
hydrocodone and tramadol without a legitimate medical purpose.
In the Eastern District of Wisconsin, three defendants were
charged in a scheme involving the unlawful distribution of controlled
substances and aggravated identity theft.
In addition, in the states of Arizona, Arkansas, California,
Connecticut, Delaware, Florida, Hawaii, Illinois, Indiana, Kansas, Louisiana,
Maine, Michigan, Missouri, Mississippi, Nevada, New York, Oklahoma,
Pennsylvania, Texas, Vermont, and Washington, 97 defendants have been charged
with defrauding the Medicaid program out of over $27 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
California, District of Columbia, Florida, Georgia, Illinois, Indiana, Iowa,
Kentucky, Louisiana, Maine, Nevada, North Carolina, Ohio, Texas, Tennessee, and
Virginia 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 in 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, Middle District of Louisiana, and the
Middle District of Florida; and agents from the FBI, HHS-OIG, DEA, DCIS,
IRS-CI, Department of Labor, other various federal law enforcement agencies,
and state Medicaid Fraud Control Units.
A complaint, information, or indictment is merely an
allegation, and all defendants are presumed innocent until proven guilty beyond
a reasonable doubt in a court of law.
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 billion in judgements and
settlements related to matters alleging health care fraud.
No comments:
Post a Comment