Tuesday, July 3, 2018

DOJ Arrests in $2B Health Care Fraud Takedown

Lilly Hummel


The U.S. Department of Justice (DOJ) and the U.S. Department of Health, Office of Inspector General (OIG) announced the largest health care fraud takedown in history. Approximately 601 defendants in 58 federal districts were charged with participating in fraud schemes involving approximately $2 billion in false billings to the Medicare and Medicaid programs. According to the DOJ press release, the accused parties were charged with various health care fraud-related crimes, including 162 defendants charged for their roles in prescribing and distributing opioids and other dangerous narcotics.

More so than in prior years’ fraud take-downs, this year’s charges focused on schemes billing Medicare, Medicaid, TRICARE (a health insurance program for members and veterans of the armed forces and their families), and private insurance companies for medically unnecessary prescription drugs and compounded medications that often were never purchased and/or distributed to beneficiaries.  The charges also involve individuals contributing to the opioid epidemic, with a particular focus on medical professionals involved in the unlawful distribution of opioids and other prescription narcotics, a particular focus for the Department. The OIG has released a fact sheet about the takedown, describing the scope, schemes, use of data analytics and administrative enforcement actions.

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