Health Care Fraud Takedown
Nationwide Sweep Targets Enablers of Opioid Epidemic
Federal officials today announced charges against more than 400 individuals—including doctors, nurses, and licensed medical professionals—for their roles in fraud schemes involving about $1.3 billion in false Medicare billings.
The coordinated nationwide sweep by more than 1,000 law enforcement personnel—operating as part of the Medicare Fraud Strike Force—is the largest action to date. Of the 412 individuals charged, one in four cases involved opioid-related crimes, underscoring the scope of what federal officials are calling a drug-abuse epidemic that is killing approximately 91 Americans every day.
“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 at the U.S. Department of Justice, where he joined Attorney General Jeff Sessions and the heads of the Department of Health and Human Services (HHS) and the Drug Enforcement Agency (DEA) in announcing the charges. “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.”
Additionally, HHS began suspending 295 providers—including doctors, nurses, and pharmacists—so they can no longer participate in federal health programs like Medicare, Medicaid, and TRICARE, a health insurance program for veterans and the military.
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.
The charges—which span 41 federal districts—are the culmination of deep dives into the submissions and payment data at the federal health insurance programs, which can reveal trends and anomalies that investigators at the HHS Office of Inspector General (OIG) can then probe and send to federal, state, and local law enforcement partners to further investigate. In addition to more than 300 OIG agents, this year’s Medicare Fraud Strike Force action included 350 FBI personnel from 28 field offices. The FBI’s Health Care Fraud Unit started a Prescription Drug Initiative specifically to go after individuals who overprescribe opioids or seek to profit from illegally selling prescription narcotics.
According to the Government Accountability Office, fraud, waste, and abuse account for more than 10.8 percent of Medicare spending—or $75 billion annually.
“These people inflicted a special kind of damage.”
FBI Acting Director Andrew McCabe
“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.
“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.”
“With great privilege and great authority comes great responsibility to handle and prescribe controlled drugs lawfully, carefully, and thoughtfully.”
Chuck Rosenberg, acting administrator, DEA