July 14, 2017

412 people charged in alleged health care fraud schemes

Daily Briefing

The Department of Justice (DOJ) on Thursday announced that federal authorities have charged 412 individuals with defrauding federal health care programs.

How your hospital board can become the first line of defense against fraud

Details of the charges

DOJ said the charges involve about $1.3 billion in fraudulent claims and account for "the largest ever health care fraud enforcement action by the Medicare Fraud Strike Force."

The charges stem from schemes to submit fraudulent claims to Medicare, Medicaid, and TRICARE for unnecessary prescription drugs, compounded drugs, and other services that often were not actually purchased or given to beneficiaries. DOJ said, in many cases, individuals involved in the scheme allegedly received "cash kickbacks in return for supplying beneficiary information to providers, so that the providers could then submit fraudulent bills to Medicare for services that were medically unnecessary or never performed."

DOJ said 115 of the 412 people involved in the charges were physicians, nurses, or other licensed medical professionals. According to DOJ, more than 120 of the individuals face charges related to their parts in unlawfully prescribing and distributing opioids and other narcotic drugs. Acting FBI Director Andrew McCabe said in some instances, single physicians had written prescriptions for more controlled substances than entire hospitals had over the same time period.

DOJ said HHS also has begun suspension actions against 295 health care providers.

Comments

HHS Secretary Tom Price said, "Health care fraud is not only a criminal act that costs billions of taxpayer dollars—it is an affront to all Americans who rely on our national health care programs for access to critical health care services and a violation of trust."

He continued, "The historic results of this year's national takedown represent significant progress toward protecting the integrity and sustainability of Medicare and Medicaid, which we will continue to build upon in the years to come" (Ruiz, New York Times, 7/13; Department of Justice release, 7/13; Johnson, USA Today, 7/13; Greenwood, The Hill, 7/13; Schoenberg/McLaughlin, Bloomberg, 7/13).

Get our health care cheat sheets on key legal landmarks

book

Access our health care legal landmarks cheat sheets that offer overviews of some of the most significant U.S. health care legislation.

Download cheat sheets on: Antitrust, Fraud and abuse, HIPAA, MACRA, and the Two-midnight rule.

Download the Cheat Sheets

X
Cookies help us improve your website experience. By using our website, you agree to our use of cookies.