The US Department of Justice (DOJ) announced on Wednesday that it was criminally charging 78 people for their alleged involvement in healthcare fraud schemes. The alleged fraud schemes totaled over $2.5 billion and targeted the elderly, people with HIV, pregnant women and others.
“These enforcement actions, including against one of the largest health care fraud schemes ever prosecuted by the Justice Department, represent our intensified efforts to combat fraud and prosecute the individuals who profit from it,” said Attorney General Merrick B. Garland. “The Justice Department will find and bring to justice criminals who seek to defraud Americans and steal from taxpayer-funded programs.”
The defendants resided in multiple states and are accused of participating in various schemes to defraud patients and federal medical programs. The alleged schemes included telemedicine fraud, pharmaceutical fraud, opioid distribution and other types of fraud. A common thread between the schemes was overcharging patients and using fraudulent prescriptions. The charges claim defendants then received kickbacks and additional payments. Many programs engaged in marketing specifically targeted at vulnerable groups, like older patients.
“Patients trust federal health care programs to provide high quality care,” said Inspector General Christi A. Grimm of the Department of Health and Human Services Office of the Inspector General. “When bad actors steal from these programs, they hurt patients.”
One case involved the submission of $1.9 billion worth of fraudulent claims to Medicare, a federal healthcare program. Another case resulted in over $150 million being diverted from HIV patients. The DOJ alleged that many defendants used the kickbacks from these programs to purchase luxury goods, such as cars, jewelry, and yachts. The DOJ further claimed it confiscated millions of dollars worth of cars, cash and real estate from the defendants.
A full list of the complaints, informations, and indictments unsealed by the DOJ is available here.
This is the first major arrest made by the DOJ related to healthcare fraud this year. In February, 23 Michigan residents were charged with $61.5 million of Medicare fraud. The DOJ says that their recent healthcare fraud enforcement actions involve over $10 billion worth of fraud.
Healthcare fraud often results in poorer outcomes for patients, who either do not receive adequate care or have to find new providers. For example, numerous Navajo Nation residents recently lost housing due to the closure of sober living homes found to have defrauded Medicaid.
