Utah Whistleblower Hotline

Over 400 charged in health care fraud scheme totaling $1.3 billion

Photo Credit: Gage Skidmore | http://bit.ly/2tj9pW7

Photo Credit: Gage Skidmore | http://bit.ly/2tj9pW7

More than 400 people have been charged with taking part in health care fraud schemes and opioid scams that totaled $1.3 billion in false billing, Attorney General Jeff Sessions announced Thursday.

Calling the collective action the “largest health care fraud takedown operation in American history” Sessions said the scandal indicates that some doctors, nurses and pharmacists “have chosen to violate their oaths and put greed ahead of their patients.”

The people charged were illegally billing Medicare, Medicaid, and Tricare, the health insurance program that serves members of the armed forces, retired service members and their families, the Justice Department said. The allegations include claims that those charged in the health care fraud scheme billed the programs for unnecessary drugs that were never purchased or given to the patients. Among those charged is a Florida rehab facility alleged to have recruited addicts with gift cards and visits to strip clubs, leading to $58 million in false treatments and tests.

Of particular importance to officials were the individuals involved in illegally prescribing and distributing narcotic painkillers. Officials said six Michigan doctors were among the 120 people charged in the schemes for illegally prescribing and distributing narcotics.

Prescription drug abuse is a leading cause of the U.S. opioid epidemic.

Opioid (narcotic) abuse is currently a public health crisis. Prescription opioids are the leading cause of the deadly drug overdose epidemic in the U.S. In 2015, a record number of more than 52,000 Americans died of overdoses and experts believe the numbers have only continued to rise.

“In some cases [during the investigation], we had addicts packed into standing-room-only waiting rooms waiting for these prescriptions,” acting FBI director Andrew McCabe said. “They are a death sentence, plain and simple.”

Many of the prescriptions written for narcotics in this health care fraud scheme were later billed to Medicare and Medicaid – meaning taxpayers ultimately footed the expenses of this illegal activity.

“[The people who do this] 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,” Attorney General Sessions said.

The Medicaid Fraud Control Unit (“MFCU”) worked with multiple state and federal agencies during the investigation, which lasted over four years.  Investigators uncovered a number of illegal practices including false and fraudulent billing; distributing and prescribing controlled substances without legitimate medical purpose; and money laundering schemes.

Hundreds of health care providers and clinics involved.

As a result of this health care fraud scheme investigation, nearly 300 health care providers are being suspended or banned from participating in federal health care programs.

Medicaid fraud is not a victimless crime and the government takes it seriously. When licensed professionals and organizations target those who rely on Medicaid and Medicare, they’re also putting taxpayers on the hook. These illegal actions impact all of us.

One of the most valuable ways in which the government can fight health care fraud and weed out bad practitioners is through whistleblower tips. Whistleblowers not only help fight crime and save taxpayer money – they also save lives. If you have concerns about illegal activity or violations of employment, health, or safety standards and you think you may have a whistleblower case, contact us. One of our experienced whistleblower attorneys will review your claims confidentially to see if you have a case for a possible whistleblower lawsuit.