In what the U.S. Department of Justice called on Thursday the largest health care fraud enforcement action in the agency’s history, more than 400 defendants nationwide have been charged with defrauding taxpayers of $1.3 billion.
The takedown is a strong reflection of one of the new announced priorities at the DOJ under the Trump administration and new U.S. Attorney General Jeff Sessions: drugs, particularly opioid painkillers and other prescription narcotics.
Takedowns have become annual demonstrations of the federal government’s commitment to combatting the health care fraud that has cost it and taxpayers billions of dollars in recent years.
In remarks prepared to be delivered at a press conference Thursday, Sessions said that while the charges marked a “historic day,” the work of the department in this enforcement area isn’t over. “In fact, it is just beginning,” he said. “We will continue to find, arrest, prosecute, convict, and incarcerate fraudsters and drug dealers wherever they are.”
“We are sending a clear message to criminals across the country: we will find you,” Sessions added. “We will bring you to justice. And, you will pay a very high price for what you have done.”
Of the 412 charged individuals, 115 are licensed medical professionals, and 56 of those 115 are physicians, according to the DOJ. The defendants are charged with billing Medicare, Medicaid and Tricare—a health insurance program for military members, veterans and their families—for medically unnecessary prescription drugs and compounded medications that often were never even purchased or distributed to beneficiaries, as well as submitting claims for treatments that were medically necessary but often never provided.
In some of these cases, patient recruiters and beneficiaries were allegedly paid kickbacks for providing beneficiary information to providers who could then submit false bills to Medicare for services that were medically unnecessary or never provided.
More than 120 of the defendants, including physicians, were allegedly involved in the unlawful distribution of opioids and other prescription narcotics—conduct that contributes to the opioid epidemic and has proved to be a particular focus for the DOJ.
“Too many trusted medical professionals like doctors, nurses, and pharmacists have chosen to violate their oaths and put greed ahead of their patients,” Sessions said in his prepared remarks. “They seem oblivious to the disastrous consequences of their greed ... [which] are real: emergency rooms, jail cells, futures lost, and graveyards.”
In addition to action from the DOJ, the Trump administration has also formed a Commission on Combating Drug Addiction and the Opioid Crisis and high-level officials such as Health and Human Services Secretary Tom Price have stated that they are prioritizing the issue.
Gejaa Gobena, a partner at Hogan Lovells and former chief of the DOJ Criminal Division’s Health Care Fraud Unit, who oversaw four annual takedowns between 2013 and 2016, told The National Law Journal in an email that the high number of individuals charged with opioid offense is notable in this year’s takedown as compared to past years’. “The focus on providers reflects a view by law enforcement that providers are at the center of all such schemes, whether it is a standard health care fraud case or a drug diversion case involving narcotic pain medications,” he said.
Specific opioid-related cases mentioned in Sessions’ remarks as part of the 2017 takedown include:
- Six doctors accused of operating a $164 million fraudulent Medicare scheme in Michigan to prescribe patients with unnecessary opioids, some of which ended up for sale on the street.
- A fake drug treatment rehabilitation facility in Palm Beach, Florida, accused of recruiting addicts with gift cards, visits to strip clubs and even drugs in a scheme to bill more than $58 million in false treatments and tests.
- A purported pain management clinic accused of being the highest prescribing hydrocodone clinic in Houston, with about 60 to 70 people seen each day and issued medically unnecessary prescriptions in exchange for about $300 cash each visit.