DOJ Charges Hundreds With Opioid-Related Fraud

The U.S. Department of Justice (DOJ) arrested 412 individuals, including 115 licensed medical professionals, across the country for alleged involvement in health care fraud schemes totaling around $1.3 billion in false billing and “unlawful” distribution of opioids and other narcotics, according to a statement. It is the largest health care fraud enforcement action ever taken by the agency.

“While today is a historic day, the department’s work is not finished. In fact, it is just beginning,” U.S. Attorney General Jeff Sessions said in the statement. “We will continue to find, arrest, prosecute, convict, and incarcerate fraudsters and drug dealers wherever they are.”

The charges against the arrested individuals include the alleged submission of medically unnecessary claims to Medicare, Medicaid and TRICARE (an insurance program for current and former members of the military and their families), and cash payments from providers to co-conspirators for beneficiary information for the purpose of submitting fraudulent bills to Medicare. In addition, 120 individuals were charged with illegally prescribing and distributing opioids and other prescription drugs.

In the statement, the DOJ highlighted the importance of pursuing fraud in health care especially to address concerns of the opioid epidemic, citing the CDC statistic that 91 Americans die every day from an opioid overdose. The CDC also reports that from 2000 to 2015, more than a half-million people died from drug overdoses.

“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,” Tom Price, MD, the secretary of the Department of Health and Human Services, said in a statement with the DOJ. “The United States is home to the world’s best medical professionals, but their ability to provide affordable, high-quality care to their patients is jeopardized every time a criminal commits healthcare fraud.”

The arrests were made in 41 federal districts across the country with the largest group in the Southern District of Florida, where 77 individuals were charged with $141 million in fraudulent medical billing. Other arrests were made in New York, California and more than a dozen other states with similar fraud charges.

The DOJ’s statement added that “aggressively pursuing corrupt medical professionals not only has a deterrent effect on other medical professionals, but also ensures that their licenses can no longer be used to bilk the system.”

“Last year, an estimated 59,000 Americans died from a drug overdose, many linked to the misuse of prescription drugs. This is, quite simply, an epidemic,” Chuck Rosenberg, acting administrator of the Drug Enforcement Administration, said in the DOJ statement. “There is a great responsibility that goes along with handling controlled prescription drugs, and DEA and its partners remain absolutely committed to fighting the opioid epidemic using all the tools at our disposal.”


Photo courtesy of: Medical Coding News

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