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DOJ, HHS continue war on Medicare fraud with formation of new regional fraud strike force

Prosecutors for the 10 regional strike forces currently in operation have charged over 3,700 defendants.

Beth Jones Sanborn, Managing Editor

The Department of Justice has announced a new regional Medicare fraud strike force for the Newark, NJ and Philadelphia, Pennsylvania region.

The new force, which will be known as the Newark/Philadelphia Regional Medicare Fraud Strike Force, is a joint law enforcement effort combining the resources and expertise of the Health Care Fraud Unit in the Criminal Division's Fraud Section, the U.S. Attorney's Offices for the District of New Jersey and the Eastern District of Pennsylvania, as well as law enforcement partners at the FBI, U.S. Department of Health and Human Services Office of the Inspector General and U.S. Drug Enforcement Administration.

Currently there is a Medicare fraud strike force in 10 cities across the United States: Miami, Florida; Los Angeles, California; Detroit, Michigan; Houston, Texas; Brooklyn, New York; Baton Rouge and New Orleans, Louisiana; Tampa, Florida; Chicago, Illinois; and Dallas, Texas.

There is a  corporate strike force located in Washington, D.C.

To date, prosecutors in the 10 Medicare fraud strike force locations have charged over 3,700 defendants who collectively have falsely billed the Medicare program for over $14 billion.

The new strike force will include prosecutors and data analysts with the HCF Unit, prosecutors with the U.S. Attorney's Offices for the District of New Jersey and Eastern District of Pennsylvania, and special agents with the FBI, HHS-OIG and DEA.  It will work closely with such law enforcement agencies as the the U.S. Postal Inspection Service and IRS Criminal Investigation, and State Medicaid Fraud Control Units.

"The strike force will focus its efforts on aggressively investigating and prosecuting cases involving fraud, waste, and abuse within our federal health care programs, and cases involving illegal prescribing and distribution of opioids and other dangerous narcotics," the DOJ said in a statement.

The illegal prescription and distribution of opioids has been a frequent theme in healthcare frauds over the last few years, as the opioid epidemic ramped up across the U.S. In June, authorities executed the largest ever healthcare fraud takedown in history, with 601 defendants charged 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, there were 162 defendants charged for their roles in prescribing and distributing opioids and other dangerous narcotics and 76 of them were doctors.

Also in June, a CEO and four physicians from Michigan and Ohio were charged with numerous criminal counts including conspiracy to commit healthcare fraud, healthcare fraud, paying and receiving kickbacks and money laundering in connection to a massive $200 million fraud scheme involving a network of Michigan and Ohio pain clinics, laboratories and other medical providers.  

The indictment also alleged the distribution of over 4.2 million medically unnecessary opioid doses and medically unnecessary injections resulting in patient harm, according to the Department of Justice.  

April saw a former hospital CEO and two physician leaders indicted on charges related to an alleged pill mill operation they perpetrated from the hospital. John Michael Gowder and physicians David Gowder and James Heaton were indicted as part of Operation SCOPE on federal charges for illegally prescribing and obtaining thousands of prescription pain medications "outside the usual course of professional medical practice and for no legitimate medical purpose," according to the Department of Justice.

Mike and David Gowder allegedly conspired together to illegally obtain oxycodone, hydrocodone, and alprazolam, which is commonly prescribed to treat anxiety and is sold generically and under the brand name Xanax. The DOJ alleged that David Gowder unlawfully obtained these controlled substances from patients he treated at the hospital, and also illegally issued prescriptions for oxycodone, hydrocodone, and alprazolam in the names of his and Mike Gowder's family members, existing hospital patients, and patients that did not actually exist. 

Last December, a Pennsylvania physician was indicted on charges he operated a "pill mill" that improperly distributed millions of narcotic painkillers, ultimately leading to the deaths of five patients. He now faces multiple life sentences in prison.

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

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