Medicare Fraud Strike Force Charges Hundreds for Crimes Including Opioid Diversion

A partnership of federal departments announced a coordinated takedown of hundreds of defendants accused of perpetrating schemes to defraud Medicare and illegally distributing opioids.

A partnership of federal departments announced a coordinated takedown Thursday of hundreds of defendants accused of perpetrating schemes to defraud Medicare. According to a press release, many of the healthcare professionals allegedly took part in the illegal diversion of opioids.

According to a press release from the Department of Justice, Attorney General Jeff Sessions and HHS Secretary Tom Price, MD, announced the “largest ever healthcare fraud enforcement action by the Medicare Fraud Strike Force,” a partnership that includes the FBI and receives assistance from the Drug Enforcement Agency and state Medicaid fraud control units, among others.

This whirlwind of law enforcement action resulted in 412 defendants in 41 federal districts being charged with participating in fraudulent healthcare schemes resulting in a total $1.3 billion in false billings. Of these defendants, 115 were doctors, nurses, and other healthcare professionals. A common charge was billing fraud, in which the defendants allegedly charged Medicare and Medicaid for unnecessary drugs that were sometimes not even received by patients.

Agents also brought charges for kickback schemes, identity theft, embezzlement, and other crimes with sometimes disastrous consequences. In one case, a nurse practitioner in Utah was charged with fraudulently obtaining a controlled substance, tampering with a consumer product, and infecting at least 7 people with hepatitis C.

A central mission of the Strike Force was to crack down on providers allegedly participating in opioid diversion or other illegal methods of distributing prescription painkillers, thus contributing to the nation's opioid crisis. Agents arrested over 120 defendants, including physicians, on charges that they illicitly prescribed or distributed opioids.

In South Florida, the owner of a so-called addiction treatment and recovery center and an accomplice were charged with submitting over $58 million in phony claims for their supposed services. Law enforcement officials accused these defendants of offering kickbacks—including gift cards, strip club visits, and drugs—to entice substance users to move to the recovery home, allowing them to keep up a steady stream of patients whose insurance they could then bill for the fraudulent treatment.

The announcement included statements from Sessions and Price, along with other law enforcement directors, condemning the defendants and their actions. Their harshest words were for physicians, considering their status as trusted healthcare professionals who should be well aware of the severity of the opioid epidemic.

“They seem oblivious to the disastrous consequences of their greed,” said Sessions of the accused. “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.”

“Healthcare fraud is not only a criminal act that costs billions of taxpayer dollars - it is an affront to all Americans who rely on our national healthcare programs for access to critical healthcare services and a violation of trust,” concurred Price.

The announcement noted that, despite the significant progress made with this batch of charges, the fight against healthcare fraud will be an ongoing one. Sessions vowed that his department would “continue to find, arrest, prosecute, convict, and incarcerate fraudsters and drug dealers wherever they are.”

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