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Feds announce massive crackdown, arrests in sweeping health care fraud probe

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WASHINGTON - Federal officials today announced the largest, most sweeping health care fraud enforcement action ever, including alleged misdoing by doctors, nurses and other health care providers.

Attorney General Jeff Sessions and Department of Health and Human Services (HHS) Secretary Alex M. Azar III, made the announcement that includes charges against 601 individuals across 58 federal districts, including 165 doctors, nurses and other licensed medical professionals, for their alleged participation in health care fraud schemes involving more than $2 billion in false billings.

Of those charged, 162 defendants, including 76 doctors, were charged for their roles in prescribing and distributing opioids and other dangerous narcotics.

Thirty state Medicaid Fraud Control Units also participated in today's arrests. In addition, HHS announced today that from July 2017 to the present, it has excluded 2,700 individuals from participation in Medicare, Medicaid, and all other Federal health care programs, which includes 587 providers excluded for conduct related to opioid diversion and abuse.

Sessions and Azar were joined in the announcement by Acting Assistant Attorney General John P. Cronan of the Justice Department's Criminal Division, Deputy Director David L. Bowdich of the FBI, Assistant Administrator John Martin of the Drug Enforcement Administration (DEA), Deputy Inspector General Gary Cantrell of the HHS Office of Inspector General (OIG), Deputy Chief Eric Hylton of IRS Criminal Investigation (CI), Centers for Medicare and Medicaid Services (CMS) Deputy Administrator and Director of the Center for Program Integrity Alec Alexander and Director Dermot F. O'Reilly of the Defense Criminal Investigative Service (DCIS).

Today's enforcement actions were led and coordinated by the Criminal Division, Fraud Section's Health Care Fraud Unit in conjunction with its Medicare Fraud Strike Force partners, a partnership between the Criminal Division, U.S. Attorney's Offices, the FBI and HHS-OIG. In addition, the operation includes the participation of the DEA, DCIS, IRS-CI, Department of Labor, other various federal law enforcement agencies, and State Medicaid Fraud Control Units.

The charges announced today aggressively target schemes billing Medicare, Medicaid, TRICARE (a health insurance program for members and veterans of the armed forces and their families), and private insurance companies for medically unnecessary prescription drugs and compounded medications that often were never even purchased and/or distributed to beneficiaries.

The charges also involve individuals contributing to the opioid epidemic, with a particular focus on medical professionals involved in the unlawful distribution of opioids and other prescription narcotics, a particular focus for the Department. According to the CDC, some 115 Americans die every day of an opioid-related overdose.

"Health care fraud is a betrayal of vulnerable patients, and often it is theft from the taxpayer," said Sessions. "In many cases, doctors, nurses, and pharmacists take advantage of people suffering from drug addiction in order to line their pockets. These are despicable crimes. That's why this Department of Justice has taken historic new steps to go after fraud, including hiring more prosecutors and leveraging the power of data analytics.

Today the Department of Justice is announcing the largest health care fraud enforcement action in American history. This is the most fraud, the most defendants, and the most doctors ever charged in a single operation--and we have evidence that our ongoing work has stopped or prevented billions of dollars' worth of fraud. I want to thank our fabulous partners with the FBI, DEA, our Health Care Fraud task forces, HHS, the Defense Criminal Investigative Service, IRS Criminal Investigation, Medicare, and especially the more than 1,000 federal, state, local, and tribal law enforcement officers from across America who made this possible. By every measure we are more effective at finding and prosecuting medical fraud than ever."

"Every dollar recovered in this year's operation represents not just a taxpayer's hard-earned money--it's a dollar that can go toward providing healthcare for Americans in need," added Azar. "This year's Takedown Day is a significant accomplishment for the American people, and every public servant involved should be proud of their work."

According to court documents, the defendants allegedly participated in schemes to submit claims to Medicare, Medicaid, TRICARE, and private insurance companies for treatments that were medically unnecessary and often never provided. 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. Collectively, the doctors, nurses, licensed medical professionals, health care company owners and others charged are accused of submitting a total of over $2 billion in fraudulent billings. The number of medical professionals charged is particularly significant, because virtually every health care fraud scheme requires a corrupt medical professional to be involved in order for Medicare or Medicaid to pay the fraudulent claims. Aggressively pursuing corrupt medical professionals not only has a deterrent effect on other medical professionals, but also ensures that their licenses can no longer be used to bilk the system.

"It takes a special kind of person to prey on the sick and vulnerable as happened in many of these health care fraud schemes," said Hylton. "Medical professionals and others callously placed individuals and vital healthcare services in harm's way simply because of greed. IRS-CI special agents continue to work side-by-side with other federal, state and local law enforcement officers to uncover these schemes and hold these criminals accountable for their actions."

Among the enforcement actions in Northern New England, in the Districts of Maine and Vermont, two defendants were charged for their roles in two schemes to defraud various government programs including Medicare, Medicaid, and ones run by the HHS' Administration for Children and Families.

In addition, in Maine and Vermont defendants along with many others across the country have been charged with defrauding the Medicaid program out of over $27 million. These cases were investigated by each state's respective Medicaid Fraud Control Units.

In addition, the Medicaid Fraud Control Units of Maine along with 15 other states and the District of Columbia participated in the investigation of many of the federal cases discussed above.

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