June 29, 2018
Dive
Brief:
- The
Department of Justice announced its largest healthcare fraud
takedown ever, charging 601 people for falsely billing
Medicare, Medicaid and the U.S. military’s TRICARE program to the tune of
more than $2 billion.
- The
massive enforcement initiative — which spanned 58 federal districts —
swept up 165 doctors, nurses and other licensed health professionals,
including 76 doctors accused of prescribing and distributing opioids and
other prescription painkillers.
- Since last July, HHS has barred
2,700 people from participating in federal healthcare programs, including
587 providers charged with opioid diversion and abuse.
Dive
Insight:
Ashlee McFarlane,
former federal prosecutor and partner at Gerger Khalil &
Hennessy, told Healthcare Dive via email that the takedown shows DOJ “is
committing significant resources to criminally prosecuting anyone who
prescribes drugs or distributes opioid prescriptions outside the normal course
of medical practice. … Federal authorities are sending a message about opioid
drug abuse in our nation and using the hammer of criminal prosecution to combat
it.”
Indeed,
162 of the 165 medical professionals nabbed in the sting were charged with
opioid-related crimes. The takedown serves as a cautionary tale for providers
that avoiding any suggestion of over-prescribing and diversion isn't just good
for patients’ health — it can save them costly fines, loss of government
reimbursement and even jail time.
The
investigations included 84 opioid cases involving more than 13 million illegal
doses of opioids, according to DOJ.
Among
those caught in the crackdown were 124 defendants in DOJ’s South Florida
district for false claims totaling more than $337 million. One sober living
facility illegally recruited patients, paid kickbacks and conducted fraudulent
urine testing, billing the government more than $106 million for alleged
substance abuse treatments.
In
a Michigan case, a doctor paid kickbacks to two home health agency owners,
resulting in more than $12 million in false insurance claims. The
widespread operations were led by DOJ’s Health Care Fraud Unit in conjunction
with the Medicare Fraud Strike Force, a collaboration of DOJ’s criminal
division, U.S. attorney’s offices, the Federal Bureau of Investigation and HHS’
Office of Inspector General.
“These
are despicable crimes,” Attorney General Jeff Sessions said in a statement.
“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.”
In
fiscal year 2017, the federal government won or negotiated more than $2.4 billion in
healthcare fraud judgments and settlements.
In
all, the government reclaimed $2.6 billion last year, including $1.4 billion
for the Medicare Trust Funds and $406.7 million in federal Medicaid money. DOJ
opened 967 criminal healthcare fraud investigations and filed 439 cases
involving 720 defendants. Of those, 639 were convicted.
https://www.healthcaredive.com/news/feds-boast-largest-healthcare-fraud-takedown-ever-at-2b-in-false-claims/526824/
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