A September to Remember for Healthcare Fraud

To say that federal healthcare fraud investigators have been busy in September would be an understatement. In the last few weeks, nearly 400 people have been implicated in a wide range of healthcare fraud related crimes totaling more than $3 billion. Included in that total are 178 medical professionals.

In addition some 50 million in controlled substances were illegally distributed across Texas, the West Coast, Gulf Coast, Northeast Florida, Georgia and the Midwest.

The crackdown culminated on Sept. 27 with charges being filed in five federal districts against 35 people associated with dozens of telemedicine companies and cancer genetic testing labs. It’s alleged the defendants fraudulently billed more than $2.1 billion for these genetic tests. Nine doctors were among those charged.

Investigators allege kickbacks and bribes were paid in exchange for the referral of Medicare beneficiaries by medical professionals working with fraudulent telemedicine companies for medically unnecessary cancer genetic tests. The elderly and disabled were their targets.

Also on Sept. 27, charges were filed against 53 people in the Midwest for their alleged involvement in Medicare fraud schemes resulting in $250 million in illegitimate billings.

A day earlier, on Sept. 26, 48 people in the Northeastern U.S., including doctors and medical professionals, were charged for their roles in submitting more than $800 million in fraudulent claims. Twenty-four were charged for their roles in diverting more than 3.25 million opioids, including a Pennsylvania doctor who is alleged to have provided drugs in exchange for sexual favors.

On Sept. 25, 67 medical and business professionals, 42 of whom are from South Florida, were swept up in a healthcare enforcement operation that the U.S. Department of Justice says spanned Florida and Georgia, and resulted in more than $160 million in fraudulent billings to Medicare, Medicaid and private insurance companies.

Also on Sept. 25, 33 people from Louisiana, Mississippi and northern Florida were charged in connection with various schemes to defraud Medicare, Medicaid and TRICARE, resulting in more than $515 million in fraudulent billings. Those charged include physicians, licensed social workers, as well as other medical and business professionals.

A week earlier, on Sept. 18, 34 people, including doctors and medical professionals, were charged in connection with a $258 million healthcare fraud scheme covering California, Arizona and Oregon.

Also on Sept. 18, 58 individuals were charged for their alleged involvement in Medicare fraud schemes and networks of pill mill clinics, resulting in $66 million in losses and 6.2 million pills being prescribed or distributed. Sixteen of those charged were doctors or medical professionals.

The allegations relating to pill mills involved the distribution and dispensing of controlled substances without a legitimate purpose.

The Justice Department has said that cracking down on medical professionals who are contributing to the nation’s opioid epidemic is one of its top priorities. According to the Centers for Disease Control, approximately 115 Americans die every day of an opioid-related overdose.

On Sept. 26, eight people in the Tampa/St. Pete area were charged for their alleged involvement in various schemes to defraud Medicare, Medicaid, and other federal healthcare benefit programs, and in various conspiracies to illicitly obtain and distribute oxycodone and other controlled substances.

DOJ launched a nationwide crackdown on doctors last year, and so far it has netted charges against 87 medical professionals relating to the illegal distribution of opioids.

Federal law provides for both civil and criminal penalties for healthcare fraud. The Health Law Offices of Anthony C. Vitale has decades of experience handling healthcare fraud and abuse cases in state and federal court, and before administrative agencies. Give us a call at 305-358-4500, or send an email to info@vitalehealthlaw.com and let’s discuss how we might be able to assist you.

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It is not intended as professional advice and should not be construed as such.