The Government executed a record nationwide healthcare takedown according to multiple measurements. The enforcement action charged hundreds of medical professionals, across the country, for a variety of frauds that totaled approximately $2 billion.

Attorney General Jeff Sessions and Secretary Alex Azar of Health and Human Services (HHS) announced “the largest ever health care fraud enforcement action” at the end of June. The sweep charged 601 individuals in total. Of these, 165 were doctors, nurses, and medical professionals like pharmacists. In addition, more than twenty state Medicaid Fraud Control Units nabbed 97 individuals for fraud totaling more than $27 million.

Coast to Coast

The charges spanned the country, occurring in 29 states and the District of Columbia. The charges alleged fraud against Medicare, Medicaid, TriCare (insuring the armed forces and veterans), as well as private insurance companies.

Reflecting Government action to fight the current crisis, a large number of charges focused on opioid fraud and abuse. These charges identified more than 160 defendants, including 76 doctors. The Government also charged a wide range of healthcare fraud, often for kickbacks or for services or drugs that were medically unnecessary or not provided at all. Listed in the press release were cases involving compound medications, home health, dentistry, ambulettes, and durable medical equipment. Some schemes even involved identity theft.

Array of federal agencies

Although an annual event, this year’s takedown demonstrated a broad effort by federal and state law enforcement agencies, as evidenced by the alphabet soup of initials for participating agencies. They included:

Center for Medicare and Medicaid Services (CMS) Center for Program Integrity,

Defense Criminal Investigative Service (DCIS),

Department of Labor (DOL),

Drug Enforcement Administration (DEA),

Federal Bureau of Investigation (FBI),

HHS Office of Inspector General (HHS-OIG),

Internal Revenue Service Criminal Investigation (IRS-CI),

Medicare Fraud Strike Force (MFSF), and

Medicaid Fraud Control Units (MFCU) from 30 states.

Other Enforcement Announcements

In addition to the criminal charges, HHS announced that 2,700 individuals had been excluded from Government healthcare programs since July 2017. Further, Medicaid announced plans for enhanced data mining to combat fraud. For more on data mining, see our prior post about the data analytics unit established at the Department of Justice.