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Recent Industry News

Health Care Compliance

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The Department of Justice (DOJ) and the Department of Health and Human Services (HHS) recently announced the largest Medicare Fraud Strike Force (MFSF) sweep to date. The MFSF is a partnership between the U.S. Attorney’s Offices, the FBI and the HHS Office of Inspector General (OIG). The fraud enforcement action resulted in charges against 412 individuals, across 41 federal districts, for nearly $1.3 billion in false billings. The enforcement actions include cases and investigations conducted by 31 additional U.S. Attorney’s Offices. Additionally, HHS has commenced suspension actions against 295 doctors, nurses and pharmacists. The fraudulent schemes involved a range of health care sectors, including home health, mental health, physical therapy, and pharmacy. Several of the charges, the DOJ highlighted, involved professionals who contributed to the opioid epidemic.

Key highlights surrounding the DOJ takedown include the following:

  • The defendants included 115 doctors, nurses and other licensed medical professionals;
  • Over 120 of the defendants were charged for their role in prescribing and distributing opioids and other dangerous narcotics;
  • Defendants allegedly committed various health care crimes involving fraud (health care, wire and mail fraud), conspiracy to commit fraud, Anti-Kickback Statute violations, money laundering and drug diversion schemes;
  • Defendants allegedly submitted Medicare, Medicaid, and TRICARE claims for medically unnecessary prescription drugs and compounded medications. Many of these drugs and medications were never purchased and/or distributed to beneficiaries;  and
  • Patient recruiters, beneficiaries and other co-conspirators were allegedly paid cash kickbacks, in many instances, to aid the providers in submitting fraudulent bills.

Since its inception in 2007, the Medicare Fraud Strike Force has collectively charged over 3500   defendants who have falsely billed Medicare for over $12.5 billion collectively.

The DOJ Justice News article is available at: https://www.justice.gov/opa/pr/national-health-care-fraud-takedown-results-charges-against-over-412-individuals-responsible.

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