Global Courant
By Sarah N. Lynch
WASHINGTON (Reuters) – The U.S. Justice Department on Wednesday announced federal and local criminal charges against 78 defendants in 16 states as part of a $2.5 billion law enforcement action involving alleged healthcare fraud programs targeting the elderly and disabled, HIV patients and even pregnant women. .
The cases range from allegations of falsely billing the federal Medicare insurance program for older and disabled Americans and paying illegal kickbacks, to the illicit misuse of expensive prescription drugs and the improper dispensing of highly addictive opioid painkillers.
Those charged include 24 doctors, nurses and other licensed medical professionals, as well as healthcare executives, including the current and former CEOs of an online durable medical device platform, accused of falsely billing $1, 9 billion in fraudulent claims.
Of the $2.5 billion in alleged fraudulent claims against Medicare, state Medicaid programs that serve the indigent and supplemental Medicare insurance programs offered by private insurers, about $1.1 billion was actually paid out to the fraudsters, officials said.
“The Justice Department will track down and try criminals who seek to defraud and steal Americans from taxpayer-funded programs,” Attorney General Merrick Garland said in a statement.
The charges, filed or unsealed June 12 through Wednesday, involved a series of cases involving similar types of plans.
Some cases were linked to expensive HIV drugs, which can bring Medicare reimbursements of up to $10,000 for a month’s supply. In one case, the owner of a New Jersey pharmaceutical wholesale distribution company was charged with illegally purchasing diverted HIV drugs and then reselling the medication by falsely claiming it was obtained through legitimate channels.
In another case, federal officials announced charges against a Wisconsin business owner accused of preying on low-income pregnant women by enticing them to sign up for prenatal care services and making false claims for services never rendered.
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Many typical Medicare fraud cases target elderly or disabled patients who have been tricked into giving their personal insurance information to telemarketers promising them that they can receive some type of testing, medical equipment, or other service paid for by Medicare at no cost to them.
In such schemes, doctors who often have no real relationship with the patients reinforce the orders by falsely stating that they are medically necessary.
The claims are submitted to federal or state insurance programs for reimbursement. Often, each person who contributes to the scheme receives payment in the form of illegal kickbacks or bribes.
The types of medical services central to such schemes usually involve those paying the highest reimbursement rates. Past examples of such services targeted by fraudsters have included durable medical devices, genetic testing and other laboratory diagnostic services.
(Reporting by Sarah N. Lynch; editing by Will Dunham)
