Sessions Announces Largest Healthcare Fraud Bust in American History
According to a Department of Justice press release, Attorney General Jeff Sessions and Health and Human Services (HHS) Secretary Tom Price announced the take down of a nationwide crime ring involving $1.3 billion in fraudulent Medicare and Medicaid billings—the largest such bust in American history.
The law enforcement operation was led by the Medicare Fraud Strike Force involving “412 charged defendants across 41 federal districts, including 115 doctors, nurses and other licensed medical professionals, for their alleged participation in health care fraud schemes involving approximately $1.3 billion in false billings. Of those charged, over 120 defendants, including doctors, were charged for their roles in prescribing and distributing opioids and other dangerous narcotics. Thirty state Medicaid Fraud Control Units also participated in today’s arrests. In addition, HHS has initiated suspension actions against 295 providers, including doctors, nurses, and pharmacists.”
This operation also touched Alabama, with arrests in the Northern and Southern Districts where “three defendants were charged for their roles in two health care fraud schemes involving pharmacy fraud and drug diversion,” according to the release.
Attorney General Sessions said,
Too many trusted medical professionals like doctors, nurses, and pharmacists have chosen to violate their oaths and put greed ahead of their patients. Amazingly, some have made their practices into multi-million dollar criminal enterprises. They seem oblivious to the disastrous consequences of their greed. Their actions not only enrich themselves often at the expense of taxpayers but also feed addictions and cause addictions to start. The consequences are real: emergency rooms, jail cells, futures lost, and graveyards. While today is a historic day, the Department’s work is not finished. In fact, it is just beginning. We will continue to find, arrest, prosecute, convict, and incarcerate fraudsters and drug dealers wherever they are.
The report noted that “Over 120 defendants, including doctors, were charged for their roles in prescribing and distributing opioids and other dangerous narcotics….In many cases, patient recruiters, beneficiaries, and other co-conspirators were allegedly paid cash kickbacks in return for supplying beneficiary information to providers, so that the providers could then submit fraudulent bills to Medicare for services that were medically unnecessary or never performed. The number of medical professionals charged is particularly significant because virtually every health care fraud scheme requires a corrupt medical professional to be involved for Medicare or Medicaid to pay the fraudulent claims.”
The nationwide scam involved healthcare providers billing for “medically unnecessary” prescriptions, prescriptions for fake drugs, and the illegal distribution of opioids through Medicare and Medicaid, as well as the U.S. Military’s TRICARE.
According to the CDC, approximately 91 Americans die every day of an opioid related overdose. “Last year, an estimated 59,000 Americans died from a drug overdose, many linked to the misuse of prescription drugs. This is, quite simply, an epidemic,” said Acting DEA Administrator Chuck Rosenberg. “There is a great responsibility that goes along with handling controlled prescription drugs, and DEA and its partners remain absolutely committed to fighting the opioid epidemic using all the tools at our disposal.”
Sessions also highlighted America’s drug epidemic, stating: “One American dies of a drug overdose every 11 minutes and more than 2 million Americans are ensnared in addiction to prescription painkillers.”
The DOJ press release said that in one Florida case, “the owner and operator of a purported addiction treatment…and one other individual were charged in a scheme involving the submission of over $58 million in fraudulent medical insurance claims for purported drug treatment services. The allegations include actively recruiting addicted patients to move to South Florida so that the co-conspirators could bill insurance companies for fraudulent treatment and testing, in return for which, the co-conspirators offered kickbacks to patients in the form of gift cards, free airline travel, trips to casinos and strip clubs, and drugs.”
“One fake rehab facility for drug addicts in Palm Beach is alleged to have recruited addicts with gift cards, visits to strip clubs, and even drugs-enabling the company to bill for over $58 million in false treatments and tests. Another illegal clinic in Houston allegedly gave out prescriptions for cash. Just one doctor at this clinic allegedly gave out 12,000 opioid prescriptions for over 2 million illegal painkiller doses. These defendants have been charged, and they will face justice,” Sessions said.
The U.S. Attorney General from Alabama concluded with a stern warning: “We are sending a clear message to criminals across the country: we will find you. We will bring you to justice. And, you will pay a very high price for what you have done.”