A historic nationwide enforcement action involving 345 charged defendants across 51 federal districts, including more than 100 doctors, nurses and other licensed medical professionals, was announced on Wednesday by Acting Assistant Attorney General Brian C. Rabbitt of the Justice Department’s Criminal Division, Assistant Administrator Tim McDermott of the Drug Enforcement Administration (DEA), Assistant Director Calvin Shivers of the FBI’s Criminal Investigative Division, and Deputy Inspector General Gary Cantrell of the Department of Health and Human Services Office of Inspector General (HHS-OIG).
These defendants have been charged with submitting more than $6 billion in false and fraudulent claims to federal health care programs and private insurers, including more than $4.5 billion connected to telemedicine, more than $845 million connected to substance abuse treatment facilities, or “sober homes,” and more than $806 million connected to other health care fraud and illegal opioid distribution schemes across the country.
(Acting Assistant Attorney General Brian Rabbitt announces cases that charge more than 300 individuals with health care fraud schemes involving more than six billion dollars in alleged health care fraud and millions of prescription opioid doses. Courtesy of Bloomberg QuickTake: Now and YouTube. Posted on Sep 30, 2020.)
Wednesday’s enforcement actions were led and coordinated by the Criminal Division, Fraud Section’s Health Care Fraud Unit, in conjunction with its Health Care Fraud and Appalachian Regional Prescription Opioid (ARPO) Strike Force program, and its core partners, the DEA, which was recognized in the 2019 ‘ASTORS’ Homeland Security Awards Program for Excellence in Public Safety, the U.S. Attorney’s Offices, HHS-OIG, and FBI, as part of the Department’s ongoing efforts to combat the devastating effects of health care fraud and the opioid epidemic.
These case are being prosecuted by Health Care Fraud and ARPO Strike Force teams from the Criminal Division’s Fraud Section, along with 43 U.S. Attorney’s Offices nationwide, and agents from DEA, HHS-OIG, FBI, and other various federal and state law enforcement agencies.
“The opioid epidemic our country is battling is exacerbated when unscrupulous individuals seek to profit from people, in particular those confronting addiction,” explained DEA Assistant Administrator McDermott.
“When doctors, pharmacists, and individuals exploit the weakness of a fellow human being in order to line their own pockets, DEA will use every tool at its disposal to stop and bring them to justice.”
“This nationwide enforcement operation is historic in both its size and scope, alleging billions of dollars in healthcare fraud across the country,” added Acting Assistant Attorney General Rabbitt.
“These cases hold accountable those medical professionals and others who have exploited health care benefit programs and patients for personal gain.”
“The cooperative law enforcement actions announced today send a clear deterrent message and should leave no doubt about the department’s ongoing commitment to ensuring the safety of patients and the integrity of health care benefit programs, even amid a national health emergency.”
“Every dollar saved is critical to the sustainability of our Medicare program and the needs of our beneficiaries,” said Centers for Medicare & Medicaid Services Administrator Seema Verma.
“We thank our partners at the Department of Justice and Department of Health and Human Services Office of Inspector General for working hard with us to identify, investigate, and eliminate waste, fraud and abuse in our federal healthcare programs.”
Telemedicine Fraud Cases
The largest amount of alleged fraud loss charged in connection with these cases – $4.5 billion in allegedly false and fraudulent claims submitted by more than 86 criminal defendants in 19 judicial districts – relates to schemes involving telemedicine: the use of telecommunications technology to provide health care services remotely.
According to court documents, certain defendant telemedicine executives allegedly paid doctors and nurse practitioners to order unnecessary durable medical equipment, genetic and other diagnostic testing, and pain medications, either without any patient interaction or with only a brief telephonic conversation with patients they had never met or seen.
Durable medical equipment companies, genetic testing laboratories, and pharmacies then purchased those orders in exchange for illegal kickbacks and bribes and submitted false and fraudulent claims to Medicare and other government insurers.
In addition to the criminal charges announced, CMS Center for Program Integrity has separately announced that it has taken a record-breaking number of administrative actions related to telemedicine fraud, revoking the Medicare billing privileges of 256 additional medical professionals for their involvement in telemedicine schemes.
“Telemedicine can foster efficient, high-quality care when practiced appropriately and lawfully,” said HHS Deputy Inspector General Cantrell.
“Unfortunately, bad actors attempt to abuse telemedicine services and leverage aggressive marketing techniques to mislead beneficiaries about their health care needs and bill the government for illegitimate services.”
“Unfortunately, audacious schemes such as these are prevalent and often harmful. Therefore, collaboration is critical in our fight against health care fraud.”
“We will continue working with our law enforcement partners to hold accountable those who steal from federal health programs and protect the millions of beneficiaries who rely on them.”
The continued focus on prosecuting health care fraud schemes involving telemedicine builds on the efforts and impact of the 2019 “Operation Brace Yourself” Telemedicine and Durable Medical Equipment Takedown, which resulted in an estimated cost avoidance of more than $1.5 billion in the amount paid by Medicare for orthotic braces in the seventeen months following that takedown.
(Learn More about “Operation Brace Yourself”; a scheme whereby Medicare was scammed out of $1 billion in healthcare funds. Courtesy of WSPA 7News and YouTube. Posted on Apr 9, 2019.)
“Sober Homes” Cases
The “sober homes” cases announced include charges against more than a dozen criminal defendants in connection with more than $845 million of allegedly false and fraudulent claims for tests and treatments for vulnerable patients seeking treatment for drug and/or alcohol addiction.
The subjects of the charges include physicians, owners and operators of substance abuse treatment facilities, as well as patient recruiters (referred to in the industry as “body brokers”).
These individuals are alleged to have participated in schemes involving the payment of illegal kickbacks and bribes for the referral of scores of patients to substance abuse treatment facilities; those patients were subjected to medically unnecessary drug testing – often billing thousands of dollars for a single test – and therapy sessions that were frequently not provided, and which resulted in millions of dollars of false and fraudulent claims being submitted to private insurers.
Medical professionals also allegedly prescribed medically unnecessary controlled substances and other medications to these patients, sometimes to entice them to stay at the facility.
The patients were then often discharged and admitted to other treatment facilities, or referred to other laboratories and clinics, in exchange for more kickbacks.
“The FBI, together with our federal, state, and local partners, remains steadfast in our commitment to identify and root out health care fraud, no matter what form it takes,” said FBI Assistant Director Shivers.
“We will continue to work tirelessly to ensure public and private health care dollars are used as intended, to promote the health and safety of all Americans and safeguard continued access to critical health care services.”
Cases Involving the Illegal Prescription and/or Distribution of Opioids
And Cases Involving Traditional Health Care Fraud Schemes
The cases involving the illegal prescription and/or distribution of opioids or that fall into more traditional categories of health care fraud include charges and guilty pleas involving more than 240 defendants who allegedly participated in schemes to submit more than $800 million in false and fraudulent claims to Medicare, Medicaid, TRICARE, and private insurance companies for treatments that were medically unnecessary and often never provided.
According to court documents, in many cases, patient recruiters, beneficiaries and other co-conspirators were allegedly paid cash kickbacks in return for supplying beneficiary information to providers, so that the providers could then submit fraudulent bills to Medicare.
Also included are charges against medical professionals and others involved in the distribution of more than 30 million doses of opioids and other prescription narcotics.
National Rapid Response Strike Force
In connection with the nationwide enforcement action, the Department of Justice also announced the creation of the National Rapid Response Strike Force of the Health Care Fraud Unit of the Criminal Division’s Fraud Section.
The National Rapid Response Strike Force’s mission is to investigate and prosecute fraud cases involving major health care providers that operate in multiple jurisdictions, including major regional health care providers operating in the Criminal-Division-led Health Care Fraud Strike Forces throughout the United States.
The National Rapid Response Strike Force led the telemedicine initiative and helped lead the sober homes cases included in the announcement.
Prior to the charges announced as part of the nationwide enforcement action and since its inception in March 2007, the Health Care Fraud Strike Force program had charged more than 4,200 defendants who have collectively billed the Medicare program for approximately $19 billion.
A complaint, information or indictment is merely an allegation, and all defendants are presumed innocent until proven guilty beyond a reasonable doubt in a court of law.
DEA Honored in 2019 ‘ASTORS’ Homeland Security Awards Program
Excellence in Homeland Security
The National Prescription Drug Take Back Day Initiative
The National Prescription Drug Take Back Day hosted by the DEA and its national, tribal and community partners aims to provide a safe, convenient, and responsible means of disposing of prescription drugs, while also educating the general public about the potential for abuse of medications.
The U.S. Coast Guard, ICE ERO and FBI IC3 Nominated in the 2020 ‘ASTORS’ Homeland Security Awards Program
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2019 ‘ASTORS’ EXCELLENCE AND GOVERNMENT AWARD RECIPIENTS
Commissioner William Bratton, Executive Chairman of Teneo Risk, the ‘2019 ‘ASTORS’ Person of the Year’
John F. Clark, CEO of the National Center for Missing and Exploited Children (NCMEC)
DHS S&T Next Generation First Responder (NGFR) Program
Dean C. Alexander, Director, Homeland Security Research Program & Professor at Western Illinois University
DHS S&T Office of Mission and Capability Support (Forensic Video Exploitation and Analysis) Tool Suite
Grant Coffey, Portland Fire & Rescue Hazmat Team Coordinator (Ret), CBRNE Industry Expert
Sheriff Tom Knight, Sarasota County Sheriff (FL)
Dr. Sean Lawler
United States Border Patrol, Border Patrol, Search, Trauma and Rescue (BORSTAR)
Dr. Konstantinos Papazoglou and Dr. Daniel M. Blumberg, Co Authors of ‘Power: Police Officer Wellness, Ethics, and Resilience’
United States Marine Corps, U.S. Marine Corps 1700 Cyberspace Operations
Congressman Brian Fitzpatrick (PA)
DOJ OPM Federal Risk Management Process Training Program
NYS Division of Homeland Security & Emergency Services UAS/Drone Training Program
Ewart Williams, New Jersey City University National Security and Intelligence Adjunct Professor
Stanley I. White, International Association for Counterterrorism & Security Professionals (IACSP)
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The traditional security marketplace has long been covered by a host of publications putting forward the old school basics to what is Today – a fast changing security landscape.
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