On July 13, the U.S. Department of Justice (DOJ) announced a nationwide takedown of unprecedented size, involving more than 1,000 law enforcement personnel including 350 Office of Inspector General (OIG) special agents. A total of 412 defendants in 41 federal districts were charged with alleged schemes involving overprescribing, illegal kickbacks to both patients and healthcare providers, and billing for unnecessary procedures and services that were never provided.
Medicare Fraud Strike Force takedowns have been an annual event in recent years, as discussed here and here. This time, individuals charged include 115 licensed professionals such as doctors, nurses, and pharmacists, as well as patient recruiters, beneficiaries, and other co-conspirators. In addition to false billing, the DOJ indicated that it aggressively targeted individuals contributing to the opioid epidemic with a focus on medical professionals unlawfully distributing prescription narcotics. The DOJ estimates that the targeted frauds account for approximately $1.3 billion in billing to Medicare, Medicaid, and TRICARE.
The takedown was led and coordinated by the Criminal Division, Fraud Section’s Health Care Fraud Unit in conjunction with its Medicare Fraud Strike Force partners, a partnership between the Criminal Division, U.S. Attorneys’ Offices, the FBI and HHS-OIG. DEA, DCIS, and State Medicaid Fraud Control Units also participated in the operation.