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DOJ announces charges against 400 people for $1.3 billion in health-care fraud

Attorney General Jeff Sessions announced charges against 412 people for $1.3 billion in health-care fraud in a news conference on July 13. (Video: The Washington Post)

More than 400 people across the country have been charged with participating in health care fraud scams totaling about $1.3 billion in false billings, including for the prescription and distribution of opioids.

In what federal officials Thursday called the “largest ever health care fraud enforcement action” by the Medicare Fraud Strike Force, 412 individuals, including 115 doctors, nurses and other licensed medical professionals, were arrested in a nationwide operation that involved more than 1,000 law enforcement agents in at least 30 states.

“One American dies of a drug overdose every 11 minutes and more than 2 million Americans are ensnared in addiction to prescription painkillers,” Attorney General Jeff Sessions said at a news conference. “We will continue to find, arrest, prosecute, convict and incarcerate fraudsters and drug dealers wherever they are.”

Sessions said the operation began with tips from people in the affected communities and from “very sophisticated computer programs that identify outliers.”

The investigation particularly focused on medical professionals who were involved in the unlawful distribution of opioids and other prescription narcotics, officials said. The abuse of pharmaceutical opioids is widely blamed for a medical crisis involving tens of thousands of overdoses on heroin and fentanyl.

“Last year, an estimated 59,000 people died from a drug overdose…opioids play an enormous role in that total number,” said Chuck Rosenberg, acting administrator of the Drug Enforcement Administration. “This is an epidemic.”

Approximately 91 Americans die every day of an opioid related overdose, according to the Centers for Disease Control and Prevention.

Among the 412 defendants, 120 were charged with opioid-related crimes. Six of the doctors were charged with operating a scheme in Michigan to prescribe unnecessary opioids, some of which were then sold on the street. The doctors allegedly billed Medicare for $164 million in fraudulent claims, according to federal officials.

A clinic in Houston allegedly gave out prescriptions for cash. Officials said one doctor at the clinic provided 12,000 opioid prescriptions for over two million illegal painkiller doses. And a rehab facility for drug addicts in Palm Beach, Fla., that is alleged to have recruited addicts with gift cards, drugs and visits to strip clubs, billed the government for over $58 million in false treatments and tests.

“Narcotics officers have arrested schoolteachers, doctors, nurses and fellow law enforcement personnel,” said acting FBI Director Andrew McCabe. “Many who succumb to the lure of the opioid high are kids…In some cases, we had addicts packed into standing-room only waiting rooms, waiting for those prescriptions.”

McCabe said that some doctors wrote out more prescriptions for controlled substances in one month than entire hospitals were writing.

Some of the health care fraud scams have been identified by local reporters in the communities where they occurred. The Palm Beach Post has covered the issue extensively and recently highlighted the Palm Beach County Sober Home Task Force, which has targeted allegedly fraudulent drug treatment centers.

And the national publication, STAT, has chronicled “addict brokers” who can earn tens of thousands of dollars by recruiting and arranging transportation and insurance coverage for addicts from the Northeast and Midwest to go to drug rehab centers in Florida. Some of the centers are run by operators with no training or expertise and they often provide few services to the addicts, according to the STAT report.

“Health care fraud is a reprehensible crime,” said Health and Human Services Inspector General Daniel Levinson. “It not only represents a theft from taxpayers who fund these vital programs, but impacts the millions of Americans who rely on Medicare and Medicaid.”

This comes amid a larger debate about how the country should address the government estimates are addicted to opioids. The epidemic has swamped hospitals, even as public health authorities urge doctors to cut back on the prescriptions they offer. The shortage of treatment for people with opiod-use disorder has even complicated efforts in Congress to repeal and replace the Affordable Care Act. States struggling with the issue have objected to a proposed roll back of the ACA’s expansion of Medicaid, which is helping fund treatment for many people, for example.

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