Attorney General Merrick Garland | U.S. Department of Justice
A multi-agency law-enforcement action that stretched across the nation and lasted two weeks resulted in criminal charges against 78 individuals for alleged health-care fraud schemes. The alleged fraud includes $2.5 billion in false claims to Medicare and other public insurers.
The U.S. Department of Justice (DOJ), in partnership with various federal and state law enforcement agencies, announced the "strategically coordinated, two-week nationwide law enforcement action" and the resultant charges on June 28. The enforcement actions "represent our intensified efforts to combat fraud and prosecute the individuals who profit from it,” Attorney General Merrick Garland said in the announcement.
“The Justice Department will find and bring to justice criminals who seek to defraud Americans and steal from taxpayer-funded programs," Garland said.
The DOJ reports the defendants are charged with defrauding programs that care for elderly and disabled individuals, and purchased "exotic automobiles, jewelry and yachts" with the proceeds. The DOJ restrained or seized automobiles, cash and real estate worth millions of dollars, the news release reports.
The enforcement action investigated telemedicine fraud, pharmaceutical fraud, opioid distribution and other types of health-care fraud, according to the release.
Charges were brought against 11 defendants for alleged telemedicine fraud connected to more than $2 billion in false claims, including of "one of the largest health care fraud schemes ever prosecuted," according to the release. In the case, the chief executive officer (CEO), former CEO and a vice president of supposed service and software firms were indicted in the Southern District of Florida for a conspiracy that allegedly resulted in the filing of $1.9 billion of false claims to government insurers such as Medicare "for orthotic braces, prescription skin creams, and other items that were medically unnecessary and ineligible for Medicare reimbursement," the release states.
"In another telemedicine fraud case," the release reports, "in the Eastern District of Washington, a licensed physician was charged for signing more than 2800 fraudulent orders for orthotic braces, including for patients whose limbs had already been amputated. As alleged, the physician took less than 40 seconds to review and sign each order."
Prescription drug, or pharmaceutical, fraud charges were filed against 10 individuals, the release reports, for alleged submitting more than $370 in fraudulent claims. In one case, defendants illegally acquired large amounts of prescription drugs that had been prescribed but not yet consumed by patients, repackaged the medication and sold them to wholesale companies which sold them to pharmacies. The pharmaceuticals, in some cases, was the wrong kind, was broken or damaged, or contained pebbles, the release states. In that case, the "defendant used his share of the proceeds to purchase luxury goods, including a $280,000 Lamborghini, a $220,000 Mercedes, and three boats," the release states.
Illegal opioid distribution and fraudulent laboratory testing allegations resulted in charges against 24 physicians and other medical professionals "who lined their own pockets, including doctors who allegedly put their patients at risk by illegally providing them with opioids they did not need," according to the release.
Assistant Attorney General Kenneth Polite Jr. of DOJ's Criminal Division said in the news release that the action "includes some of the largest and most complex cases that the Department has prosecuted, and demonstrates the Department’s commitment to seeking justice for those at all levels of the healthcare industry who put profits above patient care, from professionals in doctors’ offices to executives in corporate boardrooms."
"This nationwide enforcement action demonstrates that the Criminal Division is committed to fighting health care fraud and opioid abuse by prosecuting those who allegedly exploit patients and health care benefit programs for personal gain," Polite said in the release.
