78 Charged In DOJ’s Historic Healthcare Fraud Takedown

In a wide-reaching law enforcement operation spanning two weeks, the Justice Department, alongside numerous federal and state partners, charged 78 individuals in connection to an extensive health care fraud and opioid abuse operation reportedly worth $2.5 billion. The defendants allegedly exploited government-funded programs designed for the aid of the elderly and disabled, using the ill-gotten wealth to acquire extravagant items such as luxury vehicles, high-end jewelry, and yachts.

“The Justice Department will find and bring to justice criminals who seek to defraud Americans and steal from taxpayer-funded programs,” pledged Attorney General Merrick B. Garland. Assistant Director Luis Quesada of the FBI’s Criminal Investigative Division highlighted the unwavering dedication to battling health care fraud, asserting the operation is “a testament to the tenacity of the FBI and our partners”.

Telemedicine, a burgeoning field, emerged as a key element in the alleged fraudulent operations. Charges have been levied against 11 individuals implicated in telemedicine schemes leading to over $2 billion in fraudulent claims. As alleged, executives of supposed software and services companies conspired to create and sell falsified doctors’ orders for unnecessary medical paraphernalia, leading to $1.9 billion in fraudulent claims. This purported conspiracy involved an extensive telemarketing operation that targeted the elderly and disabled, persuading them to buy unnecessary medical equipment and prescriptions.

“Today’s announcement includes some of the largest and most complex cases that the Department has prosecuted,” underscored Assistant Attorney General Kenneth A. Polite, Jr., highlighting the severity of these telemedicine fraud cases.

In a separate disconcerting telemedicine fraud incident, charges have been laid against a physician from the Eastern District of Washington for allegedly signing off on more than 2,800 counterfeit orders for orthotic braces, shockingly, even for patients who had lost limbs to amputations. These accusations augment a series of previous enforcement actions against telemedicine fraud, cumulatively totaling over $10.1 billion.

In addition to the focus on telemedicine fraud, the crackdown also put significant emphasis on combating pharmaceutical fraud. Charges have been brought against ten individuals tied to over $370 million in fraudulent claims linked to prescription drugs. In one egregious instance, the owner of a pharmaceutical wholesale distribution company is implicated in a $150 million fraud scheme involving illegally procured prescription HIV medication, which was then rebranded and resold under false pretenses. This fraudulent operation involved deceptive “buyback” schemes and extensive misrepresentation of the medication’s provenance.

The crackdown also touched upon the illegal distribution of opioids and other forms of health care fraud, leading to over $150 million in false billings. Among those charged are 24 physicians and other licensed medical professionals, including some who allegedly put their patients at risk by illegally providing unnecessary opioids. DEA Administrator Anne Milgram emphasized the severity of such offenses, stating, “When individuals divert addictive opioid medications for personal gain, they are knowingly putting Americans at risk, all too often causing harm and even death.”

The recent enforcement action underscores the unyielding commitment of the Department of Justice and its partners to combating healthcare fraud. These efforts illuminate the significant risks and threats within our healthcare system, especially within burgeoning fields such as telemedicine. In light of these serious cases, the department’s resolve is only strengthened to uphold justice and protect those vulnerable to exploitation. The Department of Justice is urging all entities within the healthcare ecosystem – from medical professionals to healthcare providers – to uphold a high standard of vigilance and report any suspicious activities. The collective effort is indispensable in the battle against healthcare fraud.