Nationwide health care fraud takedown charges 400 enablers

Acting FBI Director Andrew McCabe speaks at a July 13, 2017 press conference at the Department of Justice announcing results of a Medicare Fraud Strike Force enforcement action as HHS Secretary Tom Price (left) and Attorney General Jeff Sessions look on. (FBI photo)

Drug-abuse epidemic killing 91 Americans each day

295 health providers—doctors, nurses, pharmacisits—suspended

Over 412 people were charged for their roles in fraud schemes involving about $1.3 billion in false Medicare billings, the FBI announced Thursday. Federal officials called it operation Medicare Fraud Strike Force, with more than 1,000 law enforcement personnel arresting individuals across the country.

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“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  General Jeff Sessions. “Amazingly, some have made their practices into multi-million dollar criminal enterprises. They seem oblivious to the disastrous consequences of their greed.”

“Their actions not only enrich themselves often at the expense of taxpayers but also feed addictions and cause addictions to start,: Sessions continued. “The consequences are real: emergency rooms, jail cells, futures lost, and graveyards.  While today is a historic day, the Department’s work is not finished. In fact, it is just beginning. We will continue to find, arrest, prosecute, convict, and incarcerate fraudsters and drug dealers wherever they are.”

Health and Human Services (HHS) began suspending 295 health providers so they can no longer participate in federal health programs like Medicare, Medicaid, and TRICARE, a health insurance program for veterans and the military.

“It’s obvious to anyone who picks up a newspaper or turns on the news that the nation is in the midst of a crisis,” FBI Acting Director Andrew McCabe said at a July 13 press conference. “Opioid abuse destroys lives and it devastates families. This week, we arrested once-trusted doctors, pharmacists, and other medical professionals who were corrupted by greed. These people inflicted a special kind of damage.”

According to Sessions and the heads of HHS and the Drug Enforcement Agency (DEA), the takedown targeted schemes that billed the federal programs for medically unnecessary prescription drugs. It also focused on medical professionals who unlawfully distributed opioids and other prescription narcotics, thereby contributing to the opioid epidemic.

Charges, spanning 41 federal districts, were the result of “deep dives into the submissions and payment data at the federal health insurance programs.” HHS investigators sent their findings to federal, state, and local law enforcement partners to further examine the potential crimes.

According to the Government Accountability Office, fraud, waste, and abuse account for more than 10.8 percent of Medicare spending—or $75 billion annually.

“We will use every tool we have to stop criminals from exploiting the vulnerable people and stealing our hard-earned tax dollars,” said Attorney General Sessions. “We are sending a clear message to criminals across this country: We will find you. We will bring you to justice. And you will pay a very high price for what you have done.”

Officials laid out case examples to illustrate to scope of the alleged crimes, including:

  • In Michigan, six physicians were charged with prescribing medically unnecessary controlled substances—some of which were sold on the street—and then billing Medicare for $164 million.
  • In Palm Beach, Florida, the owner of an addiction treatment center was charged in a scheme to submit more than $58 million in fraudulent claims—a case that alleges kickbacks of gift cards, plane tickets, and trips to casinos and strip clubs.
  • In Houston, a physician and pain management clinic owner who saw 60 to 70 clients a day allegedly issued medically unnecessary prescriptions for hydrocodone in exchange for $300 cash per visit.

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

In many cases, patient recruiters, beneficiaries and other co-conspirators were allegedly paid kickbacks in exchange for beneficiary information. The providers used this data to submit fraudulent bills to Medicare.  According to Sessions’ office, “the number of medical professionals charged is particularly significant, because virtually every health care fraud scheme requires a corrupt medical professional to be involved in order for Medicare or Medicaid to pay the fraudulent claims.  Aggressively pursuing corrupt medical professionals not only has a deterrent effect on other medical professionals, but also ensures that their licenses can no longer be used to bilk the system.”

“Their recklessness and their greed puts Americans at significant risk of addiction and death,” said Chuck Rosenberg, acting administrator at the DEA, who said four out of five new heroin users started with pain pills and about 600 new users take up heroin every day.

“With great privilege and great authority comes great responsibility to handle and prescribe controlled drugs lawfully, carefully, and thoughtfully,” Rosenberg said. “Where and when practitioners fail in that responsibility, we are going to hold them accountable.”


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