Last week, the U.S. Department of Justice announced charges against 601 individuals for their alleged participation in healthcare fraud schemes. According to the announcement, the alleged fraud is estimated to have resulted in more than $2 billion in losses to federal healthcare programs. This national healthcare fraud takedown is the largest in U.S. history, surpassing the charges announced against 412 individuals by the Justice Department in June 2017. Indeed, the magnitude of these annual takedowns has increased dramatically in recent years:
Source: Department of Justice
Spanning more than 58 federal districts, these enforcement actions were coordinated and led by the Justice Department’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 Federal Bureau of Investigation, and Department of Health and Human Services Office of Inspector General. The operation also involved the participation of 30 State Medicaid Fraud Control Units and other various federal law enforcement agencies.
The charged individuals allegedly participated in schemes that involved submitting false claims to Medicare, Medicaid, TRICARE, and private insurance companies for treatments that were medically unnecessary and or never provided. In some cases, patient recruiters, beneficiaries, and other co-conspirators allegedly were paid kickbacks in return for supplying beneficiary information to providers so that the providers could submit false claims to Medicare.
Of the 601 charged individuals, 165 are doctors, nurses, and other licensed medical professionals. In addition, 162 of the charged individuals, including 76 doctors, were specifically charged for their roles in prescribing and distributing opioids and other dangerous narcotics.
According to HHS-OIG’s fact sheet, these takedowns are an “excellent investment”: “For every $1 spent on health care related fraud and abuse investigations, more than $4 is recovered.” Since its inception in March 2007, the Medicare Fraud Strike Force teams have charged more than 3,700 individuals implicated in alleged Medicare fraud worth more than $14 billion.
*Special thanks to Hayley White for her assistance in preparing this post.