U.S. charges hundreds in nationwide health care fraud sweep Tom Schoenberg and David McLaughlin | Bloomberg News Jul 13, 2017
The U.S. charged more than 400 doctors and others in a nationwide sweep against health care fraud that cost taxpayers $1.3 billion, in part through bogus drug-treatment programs that contributed to the country’s opioid epidemic, the Justice Department said. The takedown, which Attorney General Jeff Sessions said on Thursday was the largest in U.S. history, charged doctors and other health care providers with crimes including money laundering and fraudulent claims to private insurers and the government. Many were accused of prescribing opioids and other narcotics and then illegally billing Medicaid and Medicare. “Too many trusted medical professionals like doctors and nurses and pharmacists have chosen to violate their oaths and put greed ahead of their patients,” Sessions said in Washington, announcing the first major health care enforcement action under his leadership. “Amazingly, some have made the practices into multimillion dollar criminal enterprises. They seem oblivious to the disastrous consequences of their greed.” Of the 412 people charged, 56 were doctors and 120 cases were related to opioids, Sessions said. Health care providers submitted fraudulent bills to Medicare, Medicaid and a veterans program called Tricare for services that were unnecessary or never performed. They paid kickbacks to patient recruiters and beneficiaries, the U.S. said. The government is moving to suspend or ban 295 providers, including doctors, nurses and pharmacists from participating in federal health programs, Sessions said. Arrests were made in cities including Chicago, Detroit, Los Angeles and Miami, as well as in southern Florida, which is home to hundreds of residential drug addiction treatment centers. In one case in Florida, the owner of an addiction treatment center recruited patients to bill insurance companies for fraudulent treatment and offered them kickbacks in the form of gift cards, free airline travel and trips to casinos and strip clubs, according to the Justice Department. In Texas, 26 people were charged for alleged fraud, including a doctor and the owner of a pain management clinic in Houston who are accused of improperly issuing more than 60 prescriptions a day for hydrocodone for $300 each. In Michigan, the U.S. charged 32 people with billing Medicare for procedures and prescriptions that were medically unnecessary and where some of the narcotics were resold on the street. “For most Americans, the opioid crisis tearing apart families and communities across our land is a cause of great sadness and sympathy,” Health and Human Services Secretary Tom Price said. “But a few individuals look at this national scourge and they see an opportunity to profit.” Federal prosecutors, some of whom have been working on cases for a year or more, were directed to accelerate their efforts in time for Thursday’s announcement, a person familiar with the matter said. The health care fraud takedown came as Senate Republicans released a revised bill to repeal and replace parts of the Affordable Care Act that allocates $45 billion for substance abuse treatment and recovery. Some Republicans in rejecting a previous version of the legislation said they wanted more funding to help states combat the opioid addiction epidemic. It’s unclear whether the revised bill would win enough votes to pass. More than 500,000 people received high amounts of opioid painkillers out of the 43.6 million who were signed up for Medicare’s optional prescription drug benefit last year, according to a report on opioid use released Thursday by the Office of Inspector General for the Department of Health and Human Services, which investigates waste, fraud and abuse in government health programs, including Medicare and Medicaid. A high amount is considered equivalent to 12 Vicodin 10 milligram tablets or 16 Percocet 5 milligram pills a day for at least three months. The report also identified 401 doctors who had questionable prescribing practices and were either giving opioids to patients who already received a high number or those who appeared to be doctor shopping. Those doctors wrote a total of 256,260 opioid prescriptions at risk of abusing the painkillers, costing Medicare $66.5 million. Oxycodone was the most commonly prescribed opioid. More than 33,000 Americans died from opioid overdoses in 2015, according to the National Institute on Drug Abuse. About 19,000 of those deaths are linked to heroin and synthetic opioids such as fentanyl. The overdose numbers are typically updated at the end of the year. Southern Florida has the biggest concentration of residential treatment centers in the country — hundreds are based mainly in single-family homes in and around Delray Beach, a small town in Palm Beach County, north of Miami. A December 2016 grand jury report commissioned by the State Attorney for Palm Beach County found addiction treatment centers to be rife with operators who use deceptive marketing, illegal patient brokering and fraudulent insurance claims to profit from addicts. Fraudulent claims became so rampant that Cigna Corp., the fourth-biggest U.S. health insurer, quit Florida’s Obamacare market in the fall of 2015, ahead of the sign-up period for 2016 plans. At the time, the company blamed fraudulent and abusive practices by drug-treatment centers for driving up its costs.