Member Article

On June 28, 2018, Attorney General Jeff Sessions and Department of Health and Human Services (HHS) Secretary Alex M. Azar III announced the ninth year of the national health care fraud takedown. The takedown resulted in the largest government action against health care fraud, which involved more than 600 defendants from over 50 federal districts. The targeted fraud schemes accounted for more than $2 billion in false billings. The government specifically targeted billings for prescription drugs that were medically unnecessary and charges for medicines that were never purchased.

Similar to the 2017 crackdown on opioid treatment centers alleged to have submitted false or fraudulent claim to insurers, this year investigators focused on medical professionals who illegally distributed opioids to patients. The 2018 government takedown follows a CDC report which found approximately 115 people die from opioid-related overdoses each day. According to Attorney General Sessions, “This is the most fraud, the most defendants, and the most doctors ever charged in a single operation—and we have evidence that our ongoing work has stopped or prevented billions of dollars’ worth of fraud.”

The 2018 health care fraud takedown had operations in 58 federal districts, including districts in Ohio, Kentucky, Pennsylvania, Michigan, Illinois and California. The joint task force charged three defendants located within the Southern District of Ohio for their roles in two separate health care fraud schemes. All three of the defendants were medical professionals, and one allegedly received kickbacks related to illegal drug distribution.

In Kentucky, 12 defendants were charged. Five of the defendants were medical professionals, and the charges consisted of fraud, identity theft and money laundering.

The Pennsylvania action led to charges against 16 individuals for drug diversion schemes.

In the Northern District of Illinois, the Department of Justice charged 21 defendants for health care fraud totaling more than $54 million in fraudulent billing.

Finally, in California, the task force charged 44 individuals for their alleged roles in fraud and kickback schemes. These schemes involved $660 million in fraudulent billing.

The Medicare Fraud Strike Force was established in 2007. It has grown to 10 locations and has charged more than 3,700 individuals for falsely billing more than $14 billion to Medicare. Although the takedown focuses on criminal charges, it also encompasses civil enforcement of health care fraud schemes.

Dinsmore & Shohl’s Health Care Practice Group will continue to keep its health care clients apprised of developments.

The Department of Justice press release can be found here.