More Than 400 Charged in National Health Care Fraud

In what is being called the “largest health care fraud enforcement action in Department of Justice history,” 412 individuals, including 115 health care providers, across 41 federal districts have been charged for their involvement in health care fraud and opioid distribution schemes.

According to a Department of Justice press release, the individuals allegedly participated in schemes that included false and fraudulent billings to Medicare, Medicaid, and TRICARE. Of the defendants, 120 individuals, including 27 physicians, are charged in cases involving opioid diversion.

Defendants face charges for their alleged roles in fraud, kickback, money laundering, and drug diversion schemes totaling some $1.3 billion in false billings. In one instance, a Louisiana pharmacist 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 or induced by illegal kickback payments.

In New York, 5 defendants, including 2 physicians and 2 pharmacists, were charged for their involvement in drug diversion and pharmacy fraud schemes.

Another case involves an unregistered pain clinic in Houston, Texas, that allegedly sold medically unnecessary prescriptions for hydrocodone and other controlled substances, in exchange for cash. The clinic allegedly distributed approximately 2.5 million illegal dosages of opioids. According to the indictment, patients took fraudulent prescriptions to pharmacies that would dispense the medications prescribed by the clinic physician.

As part of the takedown, officials with the Department of Health and Human Services have also initiated suspension actions against 295 providers, including physicians, nurses, and pharmacists.

Reference

National health care fraud takedown results in charges against over 412 individuals responsible for $1.3 billion in fraud losses [news release]. DOJ’s website. https://www.justice.gov/opa/pr/national-health-care-fraud-takedown-results-charges-against-over-412-individuals-responsible. Accessed July 13, 2017.