Highlighting its continued focus on cracking down on Medicare fraud and abuse practices, the U.S. Department of Justice and the U.S. Department of Health and Human Services announced this month the largest ever health care fraud enforcement action precipitated by the Medicare Fraud Strike Force.
As part of this national health care fraud takedown, the government charged 412 defendants with approximately $1.3 billion in alleged fraud. Additionally, the HHS Office of Inspector General is in the process of excluding 295 health care providers from participating in federal health care programs.
The health care providers, about 50 of them doctors, billed Medicare and Medicaid for drugs that were never purchased, collected money for false rehabilitation treatments and tests, and gave out prescriptions for cash, according to prosecutors. Some of the doctors wrote more prescriptions for controlled substances in a single month than entire hospitals wrote in that time, according to the acting FBI director who announced the prosecutions.
These arrests were made nationwide in early July by the Medicare Fraud Task Force. A record for the task force, the more than 400 prosecutions covered years of activity and were spread across more than 20 states. In particular, investigators targeted medically unnecessary prescriptions and services billed to Medicare, Medicaid or TRICARE that were often never actually provided. The government also targeted the illegal distribution of prescription narcotics by health care providers that is contributing to the wide-reaching opioid epidemic. The Centers for Disease Control and Prevention estimates that 91 Americans die each day of an opioid-related overdose.
The government highlighted the value of the task force’s work for taxpayers, citing that for every $1 spent on fraud and abuse investigations, $5 were recovered for taxpayers. Formed in 2007, the Medicare Fraud Strike Force teams bring together the efforts of the Office of Inspector General, the Department of Justice, Offices of the United States Attorneys, the Federal Bureau of Investigation, local law enforcement and others.
DOJ’s press release regarding the July takedown can be found here.
While many of these investigations appear to involve blatant fraud and abuse violators, it can sometimes be challenging for health providers to understand what constitutes fraud and abuse in a complex legal environment, or what to do if you suspect it in your organization. If you have questions, our expanded health care legal team is well versed in fraud and abuse matters.
Linda Siderius is practice group leader for the Caplan and Earnest health law team. She may be reached at 303-443-8010 or firstname.lastname@example.org.