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Numerous providers among hundreds charged in historic $2 billion healthcare fraud take-down

Authorities are calling the bust the largest in history, with hundreds charged including physicians and other medical professionals.

Beth Jones Sanborn, Managing Editor

Roughly 600 defendants across 58 federal districts, including 165 doctors, nurses and other licensed medical professionals, have been charged in what's being called the biggest healthcare fraud take-down in history. 

The alleged schemes involved more than $2 billion in false billings and almost a third of the defendants are charged for their roles in prescribing and distributing opioids and other "dangerous narcotics," the Department of Justice announced.  

Additionally, in the last year 2,700 individuals have been banned from participation in Medicare, Medicaid, and all other federal healthcare programs, including 587 providers excluded for conduct related to opioid diversion and abuse, the Department of Health and Human Services announced.

Authorities targeted alleged schemes billing Medicare, Medicaid, TRICARE and private insurance companies for prescription drugs and compounded medications that often were medically unnecessary and never actually purchased and/or distributed to beneficiaries. The individuals accused were said to be contributing to the opioid epidemic. Medical professionals involved in the unlawful distribution of opioids and other prescription narcotics were a strong focus, the DOJ said.  

According to the CDC, approximately 115 Americans die every day of an opioid-related overdose.

Citing court documents, the DOJ said the numerous defendants allegedly participated in schemes to submit fraudulent claims to Medicare, Medicaid, TRICARE, and private insurance companies for treatments that were medically unnecessary and often never provided. A major theme throughout these alleged schemes was the use of patient recruiters, beneficiaries and other co-conspirators for supplying beneficiary information to providers, so that the providers could then submit fraudulent bills to Medicare. Those recruiters, beneficiaries and other players were then allegedly paid kickbacks. Collectively, the doctors, nurses, licensed medical professionals, healthcare 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 healthcare 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," the DOJ said.

The massive takedown spanned the entire country, with individual cases from coast to coast. In the southern District of Florida, 124 defendants were charged in connection fraud schemes involving more than $337 million in false billings for services including home health care and pharmacy fraud.  

In the Central District of California, 33 defendants were charged in connection to alleged schemes aimed at defrauding insurance programs out of more than $660 million. One indictment for a compounding pharmacy fraud case said an attorney/marketer paid kickbacks and offered incentives including prostitutes and expensive meals to two podiatrists in exchange for prescriptions written on pre-printed prescription pads, whether the medications were medically necessary or not. 

Schemes in Texas, Michigan, Illinois, New York, Louisiana, Tennessee, Maine,  Vermont and others, as well as additional cases in Florida and California, also saw numerous defendants charged in cases where millions of dollars had been billed fraudulently and compound creams and opioids had been inappropriately prescribed. 

The cases 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 agents from the FBI, HHS-OIG, DEA, IRS-Criminal Investigations and other agencies.

The takedown comes as the opioid epidemic continues to scour the country, causing tens of thousands of overdoses and deaths a year. The federal government has allotted funding to combat the scourge of opioids and legislation has passed the House of Representatives that aims to boost treatment and addiction prevention initiatives. That bill, called the the SUPPORT for Patients and Communities Act, must still make its way through the Senate.

Twitter: @BethJSanborn
Email the writer: beth.sanborn@himssmedia.com

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