On Thursday, the DOJ announced charges against 412 individuals for their alleged participation in healthcare fraud schemes involving approximately $1.3 billion in false billings. This marks the largest national healthcare fraud takedown in U.S. history—topping the DOJ’s announcement of charges against 301 individuals in June 2016.
The enforcement actions spanned across 41 federal districts and were led by the DOJ Criminal Division’s Health Care Fraud Unit in conjunction with the Medicare Fraud Strike Force (a partnership between the Criminal Division, U.S. Attorney’s Offices, the FBI, and HHS-OIG). The operation also included participation by 30 State Medicaid Fraud Control Units, the DEA, and the DCIS.
Of the 412 individual defendants, 115 are licensed medical professionals—56 of whom are physicians. HHS-OIG also announced that it has initiated suspension actions against 295 providers, including doctors, nurses, and pharmacists.
According to the charging documents, the allegedly fraudulent schemes targeted by the DOJ involved claims to Medicare, Medicaid, and TRICARE (a health insurance program for members and veterans of the armed forces and their families) for medically unnecessary prescription drugs and compounded medications that were often never purchased by and/or distributed to beneficiaries. In many cases, the charges purportedly involve “patient recruiters, beneficiaries and other co-conspirators” receiving kickbacks in exchange for supplying beneficiary information to providers, so that the providers could then submit fraudulent bills for services that were either medically unnecessary or never performed. More than 120 of the defendants, including physicians, were charged for roles in the unlawful distribution of opioids and other prescription narcotics—making this also the largest opioid-related fraud takedown in U.S. history.