DOJ Unveils Massive Health Care Fraud Crackdown: 193 Charged in $2.75 Billion Scheme

In a sweeping operation across 32 federal districts, the U.S. Department of Justice (DOJ) has unveiled the results of its 2024 National Health Care Fraud Enforcement Action. The crackdown has led to criminal charges against 193 defendants, including 76 licensed medical professionals, for their alleged involvement in schemes totaling approximately $2.75 billion in intended losses and $1.6 billion in actual losses to health care programs. Attorney General Merrick B. Garland emphasized the DOJ's commitment to prosecuting those who exploit healthcare systems for profit.

"It does not matter if you are a trafficker in a drug cartel or a corporate executive or medical professional employed by a health care company, if you profit from the unlawful distribution of controlled substances, you will be held accountable," Garland stated.

The enforcement action uncovered a diverse array of fraud schemes, highlighting the complex nature of healthcare fraud:

1. A $900 million Medicare fraud in Arizona involved unnecessary amniotic wound grafts for elderly and terminally ill patients. Two defendants allegedly received over $600 million from Medicare in just 16 months for these treatments.
2. The digital health company Done faced additional charges, with five defendants accused of unlawfully distributing millions of Adderall and other stimulant pills. A Florida nurse practitioner allegedly prescribed over 1.5 million pills without proper patient interaction.
3. A $90 million conspiracy involving adulterated HIV drugs saw three pharmaceutical wholesaler executives charged for acquiring medication through illegal "buyback" schemes.
4. Addiction treatment fraud totaling $146 million involved recruiting patients from vulnerable populations, including the homeless and Native American reservations.
5. Telemedicine schemes accounted for over $1.1 billion in fraudulent Medicare claims, with 36 defendants charged.

The operation also targeted opioid-related crimes, with 14 defendants facing charges for illegal prescription and distribution. Additionally, ten defendants were charged in COVID-19 testing fraud schemes, including a $65 million case in Southern Florida.

FBI Director Christopher Wray highlighted the collaborative nature of the operation, stating, "This wide-ranging collaboration demonstrates the FBI's commitment to rooting out predatory healthcare fraud, protecting patients, and ensuring critical healthcare funds go where they are needed most."

The enforcement action was a result of extensive inter-agency cooperation, involving the FBI, DEA, HHS-OIG, and CMS. The Health Care Fraud Unit of the Criminal Division's Fraud Section led the coordination, employing advanced data analytics to identify and support investigations.

As part of the crackdown, authorities seized over $231 million in cash, luxury vehicles, gold, and other assets. The cases are being prosecuted by Health Care Fraud Strike Force teams from the Criminal Division's Fraud Section, 32 U.S. Attorneys' Offices, and 11 State Attorney Generals' Offices.

In a parallel action, the Centers for Medicare & Medicaid Services (CMS) announced administrative measures against 127 medical providers for their alleged involvement in health care fraud over the past six months.

This comprehensive enforcement action underscores the federal government's intensified focus on combating health care fraud. It demonstrates a multi-faceted approach to protecting vulnerable patients, safeguarding taxpayer-funded programs, and holding accountable those who exploit the healthcare system for personal gain. The use of advanced data analytics and inter-agency collaboration proves crucial in identifying and prosecuting these complex fraud schemes, setting a precedent for future enforcement efforts in the healthcare sector.

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