In a statement issued yesterday, Attorney General Jeff Sessions and Department of Health and Human Services (HHS) Secretary Tom Price announced the largest-ever health care fraud enforcement action engaged in by the Medicare Fraud Strike Force.  The scams totaled approximately $1.3 billion.

Overall, 412 people, including 115 doctors, nurses, and other healthcare professionals were arrested in the nationwide sweep.  Over 1,000 law enforcement agents were involved in the detentions.

Federal officials cited the opioid epidemic as a driving factor behind many of the arrests. Investigators, acting on a number of tips, along with sophisticated computer programs that searched for patterns in opioid prescribing practices, enabled law enforcement personnel to focus on a number of medical professionals involved in the unlawful distribution of opioids and other prescription narcotics. In fact, 120 of the 412 people arrested were charged with opioid-related crimes.

In addition, the charges handed down aggressively targeted schemes billing Medicare, Medicaid, and TRICARE for medically unnecessary procedures, prescription drugs, and compounded medications. In some instances, 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 to Medicare for services that were medically unnecessary or never performed. The Attorney General’s statement specifically notes that the number of medical professionals charged is particularly significant 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.  The Attorney General has committed to the aggressive pursuit of corrupt medical professionals not only for its deterrent effect on other medical professionals, but also because it ensures that they will personally be removed from the ability to engage in their professions and facilitate fraudulent schemes.

“Too many trusted medical professionals like doctors, nurses, and pharmacists have chosen to violate their oaths and put greed ahead of their patients,” said Attorney General Sessions. “Amazingly, some have made their practices into multimillion dollar criminal enterprises. They 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. The consequences are real: emergency rooms, jail cells, futures lost, and graveyards.  While today is a historic day, the Department's work is not finished. In fact, it is just beginning. We will continue to find, arrest, prosecute, convict, and incarcerate fraudsters and drug dealers wherever they are.” 

Some of the schemes included:

  • 77 charged in the Southern District of Florida in fraudulent schemes totaling over $141 million in false billing for services including home health care, mental health care and pharmacy fraud.
  • 32 charged in the Eastern District of Michigan for their roles in fraud, kickback, and money laundering and drug diversion involving over $218 million in false claims.  Medically unnecessary controlled substances were in some cases prescribed and then sold on the street.  
  • 10 individuals were charged in the Middle District of Florida with participating in a variety of schemes involving almost $14 million in fraudulent billing, $4 million of which involved a scheme to defraud the TRICARE program.  In that instance, a defendant falsely represented himself to be a retired Lieutenant Commander of the United States Navy Submarine Service. This false persona was used to gain the trust and personal identifying information of TRICARE beneficiaries, many of whom were members and veterans of the armed forces, for use in the scheme.
  • 3 Ohio defendants, husband and wife pharmacists and the medical director of a health and wellness center, engaged in multiple schemes that involved more than $3 million in healthcare fraud, including prescriptions for medically unnecessary compounded creams for pain, acne and scarring, and fraudulent billing for psychotherapy and counseling services.