7/14/17

Healthcare Fraud Crackdown Leads To Charges Against Hundreds, Including Doctors and Nurses

More than 412 individuals were charged for their part in healthcare fraud schemes that have resulted in approximately $1.3 billion in losses to consumers and the government.

The Department of Justice on Thursday announced what it calls the largest healthcare fraud enforcement action by the agency, targeting billing schemes involving Medicare, Medicaid, and TRICARE, a health insurance program for members and veterans of the armed forces and their families.

While the actions focused on alleged schemes that involved providing medically unnecessary prescription drugs and medications that often were never even purchased and/or distributed to patients, it also focused on individuals contributing to the growing opioid epidemic, such as medical professionals involved in unlawful distribution of opioids.

Related: These 101 Words May Have Pushed Opioids Into Dangerous Popularity

“Too many trusted medical professionals like doctors, nurses, and pharmacists have chosen to violate their oaths and put greed ahead of their patients,” said Attorney General Jeff Sessions.

Medical Billing Schemes

According to the DOJ, the Medicaid Fraud Strike Force took action against 412 individuals, including 115 doctors, nurses, and other licensed medical professionals for their alleged participation in healthcare fraud schemes involving approximately $1.3 billion in false billings.

These defendants allegedly participated in schemes to submit claims to Medicare, Medicaid and TRICARE for treatments that were medically unnecessary and often never provided.

In some cases, patient recruiters, beneficiaries, and other co-conspirators were allegedly paid cash kickbacks in return for supplying patient information to providers, so that the providers could then submit fraudulent bills to Medicare for services that were medically unnecessary or never performed.

The DOJ notes that the number of medical professionals charged is “particularly significant, because virtually every healthcare fraud scheme requires a corrupt medical professional to be involved in order for Medicare or Medicaid to pay the fraudulent claims.”

The Strike Force action involved individuals across the United States. In Southern Florida, 77 people were charged with offenses relating to their participation in various fraud schemes involving over $141 million in false billings for services including home healthcare, mental health services, and pharmacy fraud.

In one specific case, the owner and operator of a purported addiction treatment center and home for recovering addicts and one other individual were charged with submitting over $58 million in fraudulent medical insurance claims for treatment services.

In order to facilitate the scheme, the DOJ alleges the owner actively recruited patients to move to South Florida so that they could bill insurance companies for fraudulent treatment and testing; in return for which, the co-conspirators offered kickbacks to patients in the form of gift cards, free airline travel, trips to casinos and strip clubs, and drugs.

Here’s a rundown of the other Strike Force enforcement actions by state:

Michigan: 32 people were charged for their alleged roles in fraud, kickback, money laundering and drug diversion schemes involving approximately $218 million in false claims.

Texas: 26 individuals were charged in cases involving $66 million in alleged medical fraud.

California: 17 people were charged for their roles in schemes to defraud Medicare out of $147 million.

Illinois: 15 individuals were charged in cases related to six schemes involving $12.7 million in fraudulent billing.

Florida: Southern Florida actions involved 77 people and $141 million in fraudulent billing, while in the Middle District of Florida 10 people were charged with participating in a variety of schemes involving almost $14 million in fraudulent billing.

New York: 10 people were charged with participating in a variety of schemes including kickbacks, services not rendered, and money laundering involving over $151 million in fraudulent billings to Medicare and Medicaid.

Louisiana/Mississippi: A Strike Force operating in both states arrested seven people for their alleged connection to healthcare fraud, wire fraud, and kickback schemes involving more than $207 million in fraudulent billing.

In addition to the DOJ Task Force locations, Thursday’s enforcement actions also included cases and investigations brought by 31 U.S. Attorney’s Offices.

Opioid Crackdown

Of the 412 individuals charged for participating in healthcare fraud schemes, the DOJ notes that 120 people — including many doctors — were charged for their roles in prescribing and distributing opioids and other dangerous narcotics.

American’s dependence on opioid painkillers has increased significantly in recent years, creating what is now considered an epidemic.

In fact, the Centers for Disease Control and Prevention began urging primary care physicians to stop prescribing so many opioid painkillers. That warning came a year after a 2015 report found that 10% of doctors are writing more than 50% of the prescriptions for opioids in the U.S. The DOJ’s task force focused on some of these doctors.

Related: In Denial About America’s Opioid Painkiller Problem? This Map Might Change Your Mind

In Texas, the Strike Force arrested a physician and clinic owner for their roles in prescribing and dispensing controlled substances at a pain management clinic that is alleged to have been the highest prescribing hydrocodone clinic in Houston.

The clinic served approximately 60 to 70 people each day, who were issued medically unnecessary prescriptions for hydrocodone in exchange for approximately $300 cash per visit.

In Michigan, nine people — including six physicians — were charged with prescribing medically unnecessary controlled substances, some of which were sold on the street. The people then billed Medicare for $164 million in facet joint injections, drug testing, and other procedures that were medically unnecessary and/or not provided.

Of the actions taken by the U.S. Attorney’s offices, several included opioid-related schemes.

In the Southern District of Iowa, five defendants were charged in two schemes involving the distribution of opioids.

Three defendants were charged in a scheme involving fraudulent billings and the distribution of opioids in Tennessee.

In the Northern and Southern Districts of Indiana, at least five defendants were charged in various healthcare fraud schemes related to the unlawful distribution and dispensing of controlled substances, kickbacks, and services not rendered.

Meanwhile, in the Western District of Kentucky 11 defendants were charged with defrauding the Medicaid program. In one case, four defendants, including three medical professionals, were charged with distributing controlled substances and fraudulently billing the Medicaid program.

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