National health fraud enforcement measures result in charges of over $ 1.4 billion in alleged losses | GRANDPA

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The Justice Department today announced criminal charges against 138 defendants, including 42 doctors, nurses and other licensed health professionals, in 31 federal counties in the United States for alleged involvement in various health care fraud attempts at losses.

The charges target approximately $ 1.1 billion of fraud through telemedicine (the use of telecommunications technology to provide health services remotely), $ 29 million for COVID-19 healthcare fraud, US $ 133 million Dollars related to substance abuse treatment or “sober household” facilities. and $ 160 million related to other healthcare fraud and illegal opioid distribution systems across the country.

“This statewide enforcement action shows that the Criminal Police Department is at the forefront of combating health care fraud and opioid abuse by prosecuting those who have exploited health programs and their patients for personal gain,” said Assistant Attorney General Kenneth A. Polite Jr the Criminal Division of the Ministry of Justice. “The charges announced today send a strong chilling message and should leave no doubt about the division’s continued commitment to patient safety and the integrity of health care programs during an ongoing pandemic.”

Today’s enforcement efforts have been led and coordinated by the Health Fraud Department of the Criminal Fraud Division in conjunction with its Health Fraud and Appalachian Regional Prescription Opioid (ARPO) Strike Program and its core partner, the U.S. Attorney General of the Health and Human Services Office of Inspector General (HHS-OIG), FBI and Drug Enforcement Administration (DEA), as part of the division’s ongoing efforts to address the devastating effects of healthcare fraud and the opioid epidemic. The cases are being pursued by Health Fraud teams and ARPO Strike Force of the Criminal Fraud Division in coordination with 31 U.S. attorneys across the country and agents from HHS-OIG, FBI, DEA, and other state and state law enforcement agencies. .

“Health fraud targets the vulnerable in our communities, our health systems, and our basic expectation of competent, available care,” said Deputy Director Calvin Shivers of the FBI’s Criminal Investigation Department. “Despite an ongoing pandemic, the FBI and our law enforcement partners continue to work to protect American taxpayers and businesses from the high costs of health fraud.”

“We have seen criminals involved in healthcare fraud all too often – stealing taxpayers while compromising the health of Medicare and Medicaid recipients,” said Assistant Inspector General for Investigations Gary L. Cantrell of HHS-OIG. “Today’s announcement should serve as another warning to anyone who may be considering engaging in such illegal activity: our agency and its law enforcement partners remain relentless in our efforts to detect fraud, hold malicious actors accountable, and the.” To protect millions of beneficiaries who rely on it “on federal health programs.”

“Bringing those responsible for healthcare fraud and prescription drug diversion to justice is a priority for DEA,” said DEA Administrator Anne Milgram. “These fraudulent activities prey on our weakest – those in pain, drug addicts, and even the homeless – the ones most vulnerable to promises of relief, recovery, or a fresh start. These plans not only benefit from desperation, but often leave their victims deeper into the addiction. We are grateful to our partners who stand by our side to make our communities safer and healthier through our joint efforts to prevent the abuse and overprescription of controlled drugs. “

“Every dollar saved is critical to the sustainability of our Medicare programs and meeting the needs of seniors and people with disabilities,” said Chiquita Brooks-LaSure, administrator of the Centers for Medicare & Medicaid Services (CMS). “CMS has taken action against 28 vendors on behalf of those with Medicare insurance and to protect the Medicare Trust Fund. Measures like these to combat fraud, waste and abuse in our federal programs would not be possible without the successful partnership between the Centers for Medicare & Medicaid Services, the Department of Justice and the US Department of Health, Office of Inspector General. ”

Telemedicine Fraud Cases

The largest amount of alleged fraudulent losses indicted in connection with the cases announced today – over $ 1.1 billion in alleged false and fraudulent claims from more than 43 defendants in 11 jurisdictions – relates to telemedicine programs. According to court documents, certain defendant telemedicine executives allegedly paid doctors and nurses to order unnecessarily long-life medical equipment, genetic and other diagnostic tests, and pain relievers, either with no patient interaction or just a brief phone call with patients they had never met had or seen. Long-life medical device companies, genetic testing laboratories, and pharmacies then bought those orders in exchange for illegal kickbacks and bribes and filed false and fraudulent claims with Medicare and other government insurers for $ 1.1 billion. In some cases, medical professionals billed Medicare bogus telehealth consultations that did not take place as shown. Proceeds from the program were spent on luxury goods such as vehicles, yachts, and real estate.

The continued focus on tracking healthcare fraud attempts using telemedicine reflects the success of the nationwide coordinating role of the Fraud Section’s National Rapid Response Strike Force, announced at the 2020 National Health Care Fraud and Opioid Takedown. The National Rapid Response Strike Force helped coordinate the pursuit of the Telemedicine Initiative, Sober Homes Initiative, and COVID-19 cases announced today. The focus on telemedicine fraud also builds on the telemedicine component of the nationwide shutdown last year and the impact of the Operation Brace Yourself shutdown of telemedicine and long-life medical devices in 2019, resulting in an estimated cost avoidance of more than 1.9 billion US dollars of the amount paid carried by Medicare for orthotics for the 20 months following this deactivation.

COVID-19 fraud cases

Nine defendants in the cases announced today were believed to have been implicated in various healthcare fraud attempts aimed at exploiting the COVID-19 pandemic, resulting in over $ 29 million in false bills. In one type of program, the defendants are alleged to have exploited policies put in place by the CMS to provide improved access to medical care during the COVID-19 pandemic, such as expanded regulations and rules for telemedicine. The defendants allegedly misused patient records to bring claims to Medicare for unrelated, medically unnecessary and expensive laboratory tests, including genetic cancer tests.

The prosecution today also includes criminal charges against five defendants allegedly involved in misusing funds from the Provider Relief Fund. The Provider Relief Fund is part of the Coronavirus Aid, Relief, and Economic Security (CARES) Act, a federal law passed in March 2020 to provide medical care to Americans suffering from COVID-19. The defendants allegedly used the funds for their own personal expenses, including gambling at a Las Vegas casino and paying for a luxury car dealership.

The COVID-19 cases announced today build on the success of the health fraud shutdown on the 26th National Rapid Response Strike Force will conduct and organize efforts to combat illegal activity-related health programs during the pandemic.

Cases from Sober Homes

The sober house cases will be announced on the one year anniversary of the first national sober house initiative in 2020, bringing charges against more than a dozen defendants related to allegedly false and fraudulent allegations of testing and treatment totaling more than US $ 845 million – Dollars included for vulnerable patients seeking treatment for drug and / or alcohol addiction. The over $ 133 million in false and fraudulent claims made in the cases announced today reflect the continued efforts of the National Rapid Response Strike Force and the Los Angeles Strike Force of the Health Care Fraud Unit, with the participation of the U.S. District Attorneys for the Central District of California and Southern District of Florida to prosecute those who participated in illegal kickback and bribery programs that referred patients to substance abuse treatment facilities; These patients could be subjected to medically unnecessary drug tests – often costing thousands of dollars for a single test – and therapy sessions that were often not done and that resulted in millions of false and fraudulent claims being filed with private insurers.

Cases related to the illicit prescribing and / or distribution of opioids and cases involving traditional healthcare fraud systems

The illicit opioid prescribing and / or distribution cases announced today involve 19 defendants, including multiple charges against medical professionals and others who prescribed over 12 million doses of opioids and other prescription narcotics while also serving over $ 14 million in false bills submitted. Cases that fall into the more traditional health care fraud categories include charges against over 60 defendants who allegedly participated in programs for more than $ 145 million in false and fraudulent claims against Medicare, Medicaid, TRICARE and private Submitting to insurance companies for medically performed treatments is unnecessary and often never provided.

Prior to the charges announced as part of today’s statewide enforcement action, and since it was launched in March 2007, the Health Care Fraud Strike Force, which maintains 15 emergency responders in 24 districts, has indicted more than 4,600 defendants who collectively under the Medicare program have billed for around $ 23 billion. In addition to the criminal measures announced today, CMS, in partnership with HHS-OIG, announced 28 administrative measures to reduce the presence of fraudulent providers.

A complaint, information or indictment is just an accusation and all defendants are presumed innocent until proven guilty in a court of law.

To see Deputy Attorney General Polite’s comments, see https://www.justice.gov/opa/video/assistant-attorney-general-kenneth-polite-jr-delivers-remarks-health-care-enforcement.


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