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HHS $2B Healthcare Fraud Takedown

The Department of Justice is taking on “the most defendants ever charged in health care fraud” as the nationwide opioid crisis continues. Almost 200 doctors and 220 other medical professionals have been charged with opioid-related crimes since January 2017. According to Attorney General, Jeff Sessions, “this is the most doctors and the most medical personnel, and the most fraud that the Department of Justice has ever taken on in any single enforcement action.”

Investigations

The Department of Health and Human Services (HHS) has spearheaded investigations identifying beneficiaries receiving high dosages of opioids well in excess of guidelines. HHS Inspector General for Investigations, Gary Cantrell, released a report probing Medicare Part D spending as it relates to opioids. The results show 460,000 beneficiaries were receiving excessive dosages, and 300 medical professionals were identified as prescribers of questionable dosages of opioids. One person charged worked at a rehab facility, prescribed drugs without a license, and worked with other facilities to “bilk those who were trying to enter recovery.”

In addition to criminal opioid charges, HHS and the FBI have investigated billing charges defrauding Medicare, Medicaid, and private insurers. The Health Care Fraud Unit of the DOJ announced that more than 3,700 people have been charged with more than $14 billion worth of fraudulent billing for unnecessary prescriptions and compounded medications since March 2007.

Government Action

Since 2007, charges for opioid billing fraud have come down in states across the country, including Florida, Texas, New York, New Jersey, California, Delaware, Pennsylvania, Illinois and the District of Columbia. In response, the DOJ has launched the Prescription Interdiction & Litigation Task Force that will, in coordination with law enforcement and the Department of HHS, use criminal and civil law including the False Claims Act and Controlled Substances Act to crack down on opioid makers and distributors.

Takeaway

Following investigations confirming the widespread fraud and need for legal action to combat the nationwide opioid epidemic, the Department of Justice is taking action against fraudulent doctors and medical professionals in large numbers. Existing statutory regulations including the False Claims Act and Controlled Substance Act provide legal basis for both criminal and civil charges to combat both opioid crimes and billing fraud.

For insurers who suspect billing fraud, contact the knowledgeable legal team at Parker, LLP Attorneys at Law. With a proven track record in detecting fraud, our attorneys are here to help stop your company from paying unnecessary claims.

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