FEDERAL HEALTH CARE FRAUD TAKEDOWN IN NORTHEASTERN U.S. RESULTS IN CHARGES AGAINST 48 INDIVIDUALS
Three Plead Guilty to One of Largest Health Care Fraud Schemes Prosecuted Involving Fraudulent Telemedicine Networks Targeting Elderly Patients Nationwide
WASHINGTON – The Justice Department today announced a coordinated health care fraud enforcement action across seven federal districts in the Northeastern United States, involving more than $800 million in loss and the distribution of over 3.25 million pills of opioids in “pill mill” clinics. The takedown includes new charges against 48 defendants for their roles in submitting over $160 million in fraudulent claims, including charges against 15 doctors or medical professionals, and 24 who were charged for their roles in diverting opioids.
In addition to the new charges, today’s enforcement action also includes the guilty pleas of three corporate executives, including the Vice President of Marketing of numerous telemedicine companies and two owners of approximately 25 durable medical equipment companies, for their roles in causing the submission of over $600 million in fraudulent claims to Medicare. This is one of the largest health care fraud schemes ever investigated by the FBI and the U.S. Department of Health and Human Services Office of the Inspector General (HHS-OIG) and prosecuted by the United States Attorney’s Offices for the District of New Jersey, Eastern District of Pennsylvania, Western District of Pennsylvania, Eastern District of New York, Western District of New York, District of Connecticut and District of Columbia.
Today’s enforcement actions were led and coordinated by the Health Care Fraud Unit of the Criminal Division’s Fraud Section in conjunction with its Medicare Fraud Strike Force (MFSF), as well as the U.S. Attorney’s Offices for the mentioned districts. The MFSF is a partnership among the Criminal Division, U.S. Attorney’s Offices, the FBI and HHS-OIG. In addition, IRS-Criminal Investigations (IRS-CI), Department of Defense-Defense Criminal Investigative (DoD-DCIS), Food and Drug Administration-Office of Inspector General (FDA-OIG), U.S. Postal Service-Office of Inspector General (USPS-OIG), the Medicaid Fraud Control Unit and other federal and state law enforcement agencies participated in the operation.
The charges and guilty pleas announced today continue to target corporate health care fraud involving fraudulent telemedicine companies and the solicitation of illegal kickbacks and bribes from health care suppliers in exchange for the referral of Medicare beneficiaries for medically unnecessary durable medical equipment and other testing. The charges also involve individuals contributing to the opioid epidemic, including medical professionals involved in the unlawful distribution of opioids and other prescription narcotics, a particular focus for the United States Attorney’s Offices.
According to the Centers for Disease Control, approximately 115 Americans die every day of an opioid-related overdose. Today’s arrests and guilty pleas come one-year after the United States Attorney’s Offices announced the formation of the Newark/Philadelphia Regional Medicare Fraud Strike Force, a joint law enforcement effort that brings together the resources and expertise of the Health Care Fraud Unit in the Criminal Division’s Fraud Section, the U.S. Attorney’s Offices for the District of New Jersey and the Eastern District of Pennsylvania, as well as law enforcement partners.
The Centers for Medicare & Medicaid Services, Center for Program Integrity (CMS/CPI) announced today that all appropriate administrative actions would be taken based on these charges. As part of the announcement in April, CMS/CPI announced that it took administrative action against 130 DME companies that submitted over $1.7 billion in claims to the Medicare program.
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Key Facts
- State: New York
- Category: Fraud & Financial Crimes
- Source: DOJ Press Release â†â€â€
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