The U.S. Department of Justice on Sept. 30 announced a nationwide takedown of 345 charged defendants—including more than 100 doctors, nurses and other licensed medical professionals—on suspicion of submitting more than $6 billion in false and fraudulent claims to federal healthcare programs and private insurers. It is the largest healthcare fraud and opioid enforcement action in Justice Department history.
The claims, which involve defendants in 51 federal districts, included:
- More than $4.5 billion in activities connected to telemedicine
- More than $845 million in connection with substance treatment facilities and sober homes
- More than $806 million in connection with other fraudulent activities and illegal opioid distribution schemes
The enforcement action was announced by: Acting Assistant Attorney General Brian C. Rabbitt of the Justice Division’s Criminal Division, Assistant Director Calvin Shivers of the FBI’s Criminal Investigative Division, Deputy Inspector General Gary Cantrell of the HHS Office of the Inspector General, and DEA Assistant Administrator Tim McDermott.
“The opioid epidemic our country is battling is exacerbated when unscrupulous individuals seek to profit from people, in particular those confronting addiction,” McDermott said in a Justice Department news release. “When doctors, pharmacists, and individuals exploit the weakness of a fellow human being in order to line their own pockets, DEA will use every tool at its disposal to stop and bring them to justice.”
In the telemedicine fraud cases, which included 86 defendants in 19 districts, telemedicine executives are suspected of paying doctors and nurse practitioners to order unnecessary medical equipment, testing and pain medications. Durable equipment companies, testing labs and pharmacies then purchased those orders in exchange for illegal kickbacks and submitted fraudulent claims to Medicare and other government insurers.
The sober homes cases included fraudulent claims for testing and treatments that involved physicians, treatment facility owners and operators, and patient recruiters. The alleged schemes included kickbacks and bribes for patient referrals, patients being subjected to medically unnecessary testing, therapy sessions that were never provided, and medically unnecessary medications. Patients were also sent to other facilities or referred to other labs in exchange for more kickbacks.
The illegal distribution cases involved more than 240 defendants who submitted false claims to Medicare, Medicaid, TRICARE and private insurers for unnecessary treatment and services that in some cases were never provided. Cases involved patient recruiters, beneficiaries and co-conspirators who were paid cash kickbacks for supplying beneficiary information to providers, who then submitted fraudulent bills to Medicare. Charges also include medical professionals and defendants allegedly distributing more than 30 million doses of opioids and other prescription narcotics.