Department of Justice
National healthcare fraud enforcement action results in charges involving more than $1.4 billion in alleged losses
Six defendants, more than $50 million in Southern District of Georgia
WASHINGTON: A strategically coordinated, six-week nationwide federal law enforcement action has resulted in criminal charges against 138 defendants, including 42 doctors, nurses, and other licensed medical professionals, in 31 federal districts across the United States for their alleged participation in various healthcare fraud schemes for more than $1.4 billion in alleged losses.
The enforcement action includes criminal charges against six defendants here in the Southern District of Georgia. The charges announced involve some defendants accused of committing a kickback conspiracy involving cancer genomic testing claims, and other defendants accused of illegal distribution of opioids. The Southern District of Georgia’s announced charges account for more than $50 million in collective billings to federal health benefit programs.
Nationwide, the charges target approximately $1.1 billion in fraud committed using telemedicine, more than $29 million in COVID-19 health care fraud, more than $133 million connected to substance abuse treatment facilities, or “sober homes,” and more than $160 million connected to other health care fraud and illegal opioid distribution schemes across the country.
“The vigilance of our law enforcement partners plays a vital role in identifying illegal healthcare activities throughout the nation and the Southern District of Georgia,” said David H. Estes, Acting U.S. Attorney for the Southern District of Georgia. “We will continue to hold accountable those who would seek to gain illicit profit by criminally exploiting our nation’s healthcare safety net.”
“This nationwide enforcement action demonstrates that the Criminal Division is at the forefront of the fight against health care fraud and opioid abuse by prosecuting those who have exploited health care benefit programs and their patients for personal gain,” said Assistant Attorney General Kenneth A. Polite Jr. of the Justice Department’s Criminal Division. “The charges announced today send a clear deterrent message and should leave no doubt about the department’s ongoing commitment to ensuring the safety of patients and the integrity of health care benefit programs, even amid a continued pandemic.”
Today’s enforcement actions were led and coordinated by the Health Care Fraud Unit of the Criminal Division’s Fraud Section, in conjunction with its Health Care Fraud and Appalachian Regional Prescription Opioid (ARPO) Strike Force program, and its core partners, the U.S. Attorneys’ Offices, the Department of Health and Human Services Office of Inspector General (HHS-OIG), FBI, and the Drug Enforcement Administration (DEA), as part of the department’s ongoing efforts to combat the devastating effects of health care fraud and the opioid epidemic. The Southern District of Georgia worked with the Justice Department’s Criminal Division and agents from HHS-OIG, FBI, and DEA in the investigation and prosecution of these cases.
Telemedicine Fraud Cases
The largest amount of alleged fraud loss charged in connection with the cases announced today – more than $1.1 billion in allegedly false and fraudulent claims submitted by 43 criminal defendants in 11 judicial districts nationwide – relates to schemes involving telemedicine: the use of telecommunications technology to provide health care services remotely. In the Southern District of Georgia, two marketers were charged by way of Information relating to their role in a conspiracy that bought and sold cancer genomic (“CGx”) testing for Medicare beneficiaries. Court documents allege that the CGx tests bought in that conspiracy were ultimately billed to Medicare by a series of laboratories for more than $45 million.
The continued focus on prosecuting health care fraud schemes involving telemedicine reflects the success of the nationwide coordinating role of the Fraud Section’s National Rapid Response Strike Force.
“Healthcare crimes hurt every taxpayer and put profits over the care of our nation’s most vulnerable citizens,” said Chris Hacker, Special Agent in Charge of FBI Atlanta. “It puts a tremendous strain on our federally-subsidized health care programs. The FBI and our federal partners will hold accountable anyone who usurps healthcare assistance for their personal greed.”
The focus on telemedicine fraud also builds on the telemedicine component of last year’s national takedown and the impact of the 2019 “Operation Brace Yourself” Telemedicine and Durable Medical Equipment Takedown, which resulted in an estimated cost avoidance of more than $1.9 billion in the amount paid by Medicare for orthotic braces in the 20 months following that takedown. The Southern District of Georgia has played a major role in these nationwide schemes, having charged more than 30 defendants responsible for a collective $1.6 billion in billings across Operation Brace Yourself, Operation Double Helix, and Operation Rubber Stamp. The Southern District of Georgia kickback charges announced today are being prosecuted by Assistant U.S. Attorney Jonathan A. Porter.
Cases Involving the Illegal Prescription and/or Distribution of Opioids and Cases Involving Traditional Health Care Fraud Schemes
The cases announced today involving the illegal prescription and/or distribution of opioids include 19 defendants, including several charges against medical professionals and others who prescribed more than 12 million doses of opioids and other prescription narcotics while submitting more than $14 million in false billings. The cases that fall into more traditional categories of healthcare fraud include charges against more than 60 defendants who allegedly participated in schemes to submit more than $145 million in false and fraudulent claims to Medicare, Medicaid, TRICARE, and private insurance companies for treatments that were medically unnecessary and often never provided.
In the Southern District of Georgia, three South Georgia medical professionals were indicted for illegal distribution of opioids and conspiracy to commit health care fraud. The indictment alleges that the charged physician, nurse practitioner, and physician assistant operated a nominal pain clinic that distributed opioids with no legitimate medical purpose. These charges are being prosecuted by Assistant U.S. Attorneys Matthew A. Josephson and Bradford C. Patrick.
“The public relies on medical professionals to be part of the solution to our nation’s prescription drug abuse epidemic – not to worsen the problem by distributing controlled substances without a legitimate medical purpose," said Special Agent in Charge Derrick L. Jackson of HHS-OIG. “Working closely with our law enforcement partners, we will continue to investigate unscrupulous providers who prey on vulnerable members of the public.”
“Medical practitioners who unlawfully dispense dangerous, addictive and potentially deadly substances do so under the guise of a stethoscope and white coat to hide behind a veil of legitimacy. They commit fraudulent acts and prey on patients who are addicted to prescription opioids and are unfit to administer care to anyone,” said Robert J. Murphy, Special Agent in Charge of the DEA Atlanta Field Division. “DEA and its law enforcement partners stand united and are committed to bringing those to justice who engage in these unlawful acts.”
Prior to the charges announced as part of today’s nationwide enforcement action and since its inception in March 2007, the Health Care Fraud Strike Force, which maintains 15 strike forces operating in 24 districts, has charged more than 4,600 defendants who have collectively billed the Medicare program for approximately $23 billion. In addition to the criminal actions announced today, CMS, working in conjunction with HHS-OIG, announced 28 administrative actions to decrease the presence of fraudulent providers.
The National Rapid Response Strike Force also announced prosecutions across the country today regarding $128 million in COVID-19 fraud, cases and nearly $1 billion in fraud cases involving sober homes.
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.
To view Assistant Attorney General Polite’s remarks, go to: https://www.justice.gov/opa/video/assistant-attorney-general-kenneth-polite-jr-delivers-remarks-health-care-enforcement.
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