Feds Launch Largest Ever Health Care Fraud Enforcement Action

Feds Launch Largest Ever Health Care Fraud Enforcement Action

Department of Justice (DOJ) officials are calling it the “largest ever health care fraud enforcement action.” More than 400 people in 30 states were arrested almost overnight for their roles in defrauding Medicare, Medicaid and other insurers of roughly $1.3 billion – mostly involving bogus claims involving sober living homes and some addiction treatment centers. The massive series of arrests also involved breaking up “patient brokering” schemes, in which real people addicted to opiates, desperate for help, are recruited off the streets by former or current people afflicted with addiction who earn commissions for sending them to shady treatment centers. These centers then file fake insurance claims, pocket millions, and seldom provide any real treatment and are traumatizing the vulnerable people who thought they were going to get help. Bryn Wesch, CFO of Novus Medical Detox Center, lauded the DOJ action and said the crackdown on fraud was badly needed. “Health care fraud drives up health care costs everywhere,” Wesch said. “Sober homes and other facilities that pay bounties for ‘recruited patients’ are often unlicensed and unaccredited. And they tend to be more focused on insurance payments than patients’ wellbeing. “They also tarnish the reputation of legitimate drug detox and treatment centers and make it more difficult for us to provide patients with proper care, because so many insurers have been burned by fraudulent or excessive claims,” Wesch added.

$1.3 billion in false billings

The DOJ says the record number of arrests by the Medicare Fraud Strike Force totaled 412 defendants across 41 federal districts, and included 115 doctors, nurses and other licensed medical professionals for their “alleged participation in health care fraud schemes involving approximately $1.3 billion in false billings.” The sweep involved more than 1,000 law enforcement agents, including 30 state Medicaid Fraud Control Units. In addition, the Department of Health and Human Services (HHS) initiated suspension actions against 295 providers, including doctors, nurses and pharmacists. Attorney General Jeff Sessions and Department of Health and Human Services Secretary Tom Price, M.D., revealed that the fraud involved fake billings for Medicare, Medicaid, and TRICARE, a health insurance program for members and veterans of the armed forces and their families, for medically unnecessary prescription drugs that often were never even purchased or distributed to patients.

Contributed to the opioid epidemic

The sweep also involved medical professionals who have contributed to the opioid epidemic by illegally selling opioids and other prescription narcotics. Among the defendants are 120 people charged with opioid-related crimes, making this “the largest opioid-related fraud takedown in American history,” the DOJ said. Just a few highlights:

  • A group of Michigan defendants – including six doctors – billed Medicare for $164 million in false and fraudulent claims prescribing unnecessary opioids which ended up for sale on the street.
  • A fake rehab facility in Palm Beach, FL, is alleged to have “recruited addicts with gift cards, visits to strip clubs, and even drugs” – enabling the company to bill over $58 million in false treatments and tests.
  • An illegal clinic in Houston allegedly sold prescription drugs to anyone for cash. One doctor allegedly sold 12,000 opioid prescriptions for over 2 million illegal painkiller doses.

Violated their oaths

“Too many trusted medical professionals like doctors, nurses, and pharmacists have chosen to violate their oaths and put greed ahead of their patients,” Sessions said. “Amazingly, some have made their practices into multimillion dollar criminal enterprises. “They seem oblivious to the disastrous consequences of their greed. Their actions not only enrich themselves often at the expense of taxpayers but also feed addictions and cause addictions to start. The consequences are real: emergency rooms, jail cells, futures lost, and graveyards.” The problem is compounded by the fact that America “is in the midst of the deadliest drug crisis in our history,” Sessions added. Drug abuse is bankrupting and breaking up families, ending friendships, causing more crime and violence and cutting short promising lives across the country, he said.

Drug industry involvement

Numerous lawsuits, from states, counties, cities – and even an Indian tribe – have been launched recently against some of the larger opioid drug makers, alleging they must know that colossal amounts of their products are being overprescribed and reaching the streets. These suits allege that the drug industry is involved in causing the opioid epidemic and should be held accountable. As expected, the companies deny such responsibility. The suits are ongoing. Meanwhile, legitimate addiction treatment centers everywhere are fully aware that they’re dealing with the results of countless millions of prescription opioids that have somehow reached the wrong hands. According to the DOJ, one American dies of a drug overdose every 11 minutes and more than 2 million Americans are ensnared in addiction to prescription painkillers. The DOJ’s Sessions is talking tough: “While today is a historic day, the Department’s work is not finished. In fact, it is just beginning. We will continue to find, arrest, prosecute, convict, and incarcerate fraudsters and drug dealers wherever they are.” Here in Florida, where it’s as bad as anywhere and often worse, Novus Medical Detox Center is at the center of the fray and working to help fight opiate addiction with several important advances in medical detoxification helping personalize treatment to make a difference one person at a time. Says Novus CFO Wesch: “I take the position that drug makers should be subject to a tax type of system that specifically funds treatment. All opioid sales, from manufacturer on down the distribution channels, should be required to funnel some of their profits into cleaning up the mess they have helped to create.”

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