National Health Care Fraud Takedown
601 Defendants Charged, More Than $2 Billion in Fraud Losses Recorded
FBI Deputy Director David Bowdich took part in a press conference today with U.S. Attorney General Jeff Sessions, Health and Human Services (HHS) Secretary Alex Azar III, and other federal officials to announce a nationwide health care fraud and opioid takedown that has resulted in charges against 601 defendants around the country, along with a total of more than $2 billion in fraud losses.
This takedown, the largest health care enforcement action taken to date by the joint Department of Justice and HHS Medicare Fraud Strike Force, involved numerous federal and state agencies working together on the front lines in the fight against health care fraud. “But our work is not finished—we are just getting started,” said Sessions. “We will continue to find, arrest, prosecute, convict, and incarcerate fraudsters and drug dealers, wherever they are.”
The charges announced today aggressively targeted schemes billing Medicare, Medicaid, TRICARE (a health insurance program for members and veterans of the armed forces and family members), and private insurance companies. Some of these schemes involved medically unnecessary prescription drugs and compounded medications that were often never even purchased and/or distributed to beneficiaries. In other cases, patient recruiters, beneficiaries, and other co-conspirators were allegedly paid cash kickbacks in return for supplying beneficiary information to providers, so that the providers could then submit fraudulent bills for services that were medically unnecessary or never performed.
According to Bowdich, “Any good criminal investigator or analyst will tell you that to find the criminals, you have to follow the money. And the people we’ve charged this week viewed our health care system as their personal ATM.”
Another focus of the operation was medical professionals allegedly involved in the unlawful distribution of opioids and other prescription narcotics.
“The people we’ve charged this week viewed our health care system as their personal ATM.”
FBI Deputy Director David Bowdich
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 these corrupt professionals not only has a deterrent effect on other medical professionals who might be tempted but also ensures that their licenses can no longer be used to bilk the system. Among those charged in this operation were 165 doctors, nurses, and other licensed medical professionals.
“These schemes harm every person who pays for health care benefits, from the patient who doesn’t get the care they need to the business that pays higher insurance costs to cover their employees, and every taxpayer who funds Medicare and Medicaid,” said Bowdich about the impact of health care fraud.
“To detect and combat these schemes,” Bowdich explained, “the FBI and our partners are using every tool we have.” But he also stressed the importance of help from the public and listed several steps that everyone can take, including reporting suspicious activity such as being offered money or free services, carefully reviewing explanation of benefits forms, protecting insurance cards and beneficiary numbers, and reporting anyone suspected of improperly prescribing or distribution of opioids. “If you suspect fraud,” he added, “please call your local FBI office or the HHS Office of Inspector General—we're all ready to help.”
In addition to the criminal charges announced today, federal authorities are aggressively pursuing civil remedies to recover fraudulently obtained health care program funds and to suspend and/or exclude corrupt providers and medical professionals from participating in federal health care programs.