On June 28, the Department of Justice said that 78 individuals had just been charged with $2.5 billion in total worth of healthcare fraud and opiate addiction schemes.
Federal prosecutors revealed several charges against over 80 individuals nationwide, including 24 healthcare professionals, who are involved in healthcare and pharmaceutical fraud schemes that cost Medicare, Medicaid, and private insurance companies billions of dollars.
Investigators said over $1 billion in allegedly false claims was handed out. The announcement follows a concerted federal and state law enforcement operation that lasted weeks and targeted healthcare organizations, providers, and other people allegedly involved in schemes to cheat taxpayer-funded programs and prey on vulnerable populations.
Investigators claimed to have confiscated many residences, automobiles, boats, and bank accounts with millions of dollars combined. According to prosecutors, one alleged scam, partially located in New Jersey, involved vendors purchasing HIV medication from patients on the street, relabeling the bottles as legally purchased medication, and selling the bottles to pharmacies for distribution.
According to representatives of the Justice Department, several bottles had stones, incorrect labels, broken tablets, and incorrect prescriptions. They said that due to the high insurance reimbursement rate for HIV treatment, which may approach $10,000 for a month's supply, it is frequently the focus of false claims.
"These enforcement actions, including against one of the largest health care fraud schemes ever prosecuted by the Justice Department, represent our intensified efforts to combat fraud and prosecute the individuals who profit from it," says Attorney General Merrick B. Garland.
He continues that criminals who attempt to swindle Americans and steal from taxpayer-funded programs will be tracked down and prosecuted by the Justice Department.
In a separate Florida case that was made public on June 27, authorities said that the owners of a software business participated in a massive fraud involving the filing of claims for the reimbursement of superfluous and ineligible medical equipment totaling $1.9 billion to Medicare and other public insurers.
The software defendants are accused of making fictitious orders, submitting them for payment, and connecting telemedicine operators, healthcare providers, and suppliers.
Per the investigators, the allegedly false submissions would have qualified the prescriptions in issue for payment. On June 28, representatives of the Justice Department stated that while telemedicine is a "powerful tool" for patients and doctors to interact swiftly, it also "provides an opportunity for fraudsters to exploit the technology."
The FBI and the Health and Human Services Department, among other federal agencies, sent investigators to help with the numerous investigations in 16 states.
This nationwide enforcement action demonstrates that the Criminal Division is committed to fighting health care fraud and opioid abuse by prosecuting those who allegedly exploit patients and health care benefit programs for personal gain.- Assistant Attorney General Kenneth Polite
A problem brought on in part by the speedy nature of certain insurance reimbursements is that just a tiny portion of the overall damages claimed in the charges issued on June 28 has been recovered.
However, officials from the Justice Department, FBI, and HHS stated on the same day that they are also concentrating on stopping the payment of fraudulent payments in the first place.
They claimed essential deterrents include tools like stripping medical providers of their billing credentials and data analytics.
Polite concludes: "Today's announcement includes some of the largest and most complex cases that the Department has prosecuted, demonstrates the Department's commitment to seeking justice for those at all levels of the healthcare industry who put profits above patient care, from professionals in doctors' offices to executives in corporate boardrooms."
- United States Department of Justice. National Enforcement Action Results in 78 Individuals Charged for $2.5B in Health Care Fraud.
- United States Department of Justice. UNITED STATES V. STEVEN DIAMANTSTEIN.
- United States Department of Justice. HEALTH CARE FRAUD UNIT.