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Feds boast largest healthcare fraud takedown ever at $2B in false claims

01 July 2018

More than 600 medical professionals across the United States now face charges in connection with the "largest (ever) health care fraud crackdown", the USA attorney's office said Thursday.

"As alleged, the defendants charged throughout the Eastern District of NY as a part of the nationwide health care takedown abused their positions to enrich themselves, while bilking Medicare and Medicaid", U.S. prosecutor Richard P. Donoghue said.

Among those charged, 162 defendants, including 76 doctors, were charged with contributing to the opioid crisis by unlawfully prescribing opioids and other narcotics.

The alleged fraud and false billings collectively accounted for 13 million illegal opioid dosages, the Justice Department said, and also included 23 pharmacists and 19 nurses. In 2016, 116 people died every day from opioid-related drug overdoses, and over eleven million people misused prescription opioids.

While the Justice Department has been conducting investigations into some opioid manufacturers like OxyContin maker Purdue Pharma LP, the cases stemming from the sweep did not focus on wrongdoing by major corporations.

The U.S. Department of Justice (DOJ) alleged the defendants were involved in a total of more than $2 billion in false billings to insurers for medically unnecessary prescription drugs and compounded medications that were never purchased or distributed to beneficiaries. Kitco Metals Inc. and the author of this article do not accept culpability for losses and/ or damages arising from the use of this publication.

In several of the cases, patient recruiters, health plan enrollees and others allegedly received kickbacks in return for coughing up insurance cards that eventually were used to file fraudulent claims with the Medicare program, according to the announcement. One case involved a pharmacy chain in Texas with fraudulent orders of more than one million hydrocodone and oxycodone pills and selling them for millions of dollars to drug transporters.

In one case, an owner, medical director, and two employees of a sober living facility were charged with conspiracy to commit health care and wire fraud, substantive counts of health care fraud, and substantive counts of money laundering.

"Health care fraud is theft and it's drug dealing", Coleman said.

"It is not that we are over-regulating, but doctors and medical practitioners are more aware", he said. The Medicare Fraud Strike Force operates in nine locations nationwide.

In the Los Angeles-based Central District, most of the medical professionals were charged with schemes to defraud health insurance programs such as Medicare.

A complaint, information, or indictment is merely an allegation, and all defendants are presumed innocent until proven guilty beyond a reasonable doubt in a court of law.

Feds boast largest healthcare fraud takedown ever at $2B in false claims