On June 28, 2018, Attorney General Jeff Sessions, together with Department of Health and Human Services (HHS) Secretary Alex M. Azar III and representatives of the FBI, DEA, and several other federal departments and agencies, announced the largest ever health care fraud enforcement action. A total of 601 individuals are charged with various health care fraud-related crimes across 58 federal districts. The defendants include 165 doctors, nurses, and other medical professionals.  All told, the fraudulent schemes amounted to more than $2 billion in false billings to Medicare, Medicaid and other federal health care programs for medically unnecessary prescription drugs and compounded medications, many of which were never purchased and/or distributed to patients.  A Justice Department statement on the enforcement action indicated that a number of charges also involve persons who have contributed to the opioid epidemic, including medical professionals involved in the unlawful distribution of opioids and other prescription narcotics.

Medical professionals represent a significant percentage of those charged in the schemes, for, as the information release from the Justice Department rightly points out, nearly every fraudulent health care scheme requires the active participation of persons involved in the provision or management of health care in order to defraud programs like Medicare and Tricare.  The Justice Department’s statement also discloses that in many instances patient recruiters, beneficiaries, and other co-conspirators were allegedly paid cash kickbacks in exchange for furnishing beneficiary information to providers, so that the providers could then submit fraudulent bills to Medicare.

“Health care fraud is a betrayal of vulnerable patients, and often it is theft from the taxpayer,” said Attorney General Sessions.  “In many cases, doctors, nurses, and pharmacists take advantage of people suffering from drug addiction in order to line their pockets. These are despicable crimes. That’s why this Department of Justice has taken historic new steps to go after fraudsters, including hiring more prosecutors and leveraging the power of data analytics….By every measure we are more effective at finding and prosecuting medical fraud than ever.”

“Every dollar recovered in this year’s operation represents not just a taxpayer’s hard-earned money—it’s a dollar that can go toward providing healthcare for Americans in need,” said HHS Secretary Azar.  “This year’s Takedown Day is a significant accomplishment for the American people, and every public servant involved should be proud of their work.”

The Health Care and Pharmacy law team at FisherBroyles welcomes your questions regarding the subject matter of this alert. Please contact any of the following attorneys:

Brian Dickerson, FisherBroyles Partner
Brian E. Dickerson

Anthony Calamunci, FisherBroyles Partner
Anthony Calamunci

Nicole Waid, FisherBroyles Partner
Nicole Hughes Waid

Amy Butler, FisherBroyles Partner
Amy Butler