U.S. charges hundreds in healthcare fraud, opioid crackdown

01 July 2018, 12:34 | Robert Harris

Feds charge 600 in opioid fraud that bilked $2B from government and insurers

U.S. Attorney General Jeff Sessions arrives for a news conference to announce a nation-wide health care fraud and opioid enforcement action at the Justice Department in Washington

In many cases, doctors, nurses, and pharmacists take advantage of people suffering from drug addiction in order to line their pockets.

According to the U.S. Centers for Disease Control and Prevention, 42,000 people in the U.S. died from opioid overdoses in 2016.

Of that staggering total, about 125 defendants were charged in South Florida with filing almost $340 million in fraudulent claims for opioid addiction treatment, home healthcare and prescription drugs covered by taxpayer-funded programs and other insurance plans.

The Centers for Medicare and Medicaid Services has recently attempted to cap the vast majority of opioid doses at 90 morphine milligram equivalents, but an increasingly vocal advocacy network of chronic pain patients forced the agency to preserve much of the flexibility in its own rules.

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 (MFSF) partners, a partnership between the Criminal Division, U.S. Attorney's Offices, the Federal Bureau of Investigation and HHS-OIG.

Among dozens of new cases in South Florida, Greenberg zeroed in on Good Decisions Sober Living in West Palm Beach, whose operators recruited patients and paid kickbacks in order to bill $106 million for widespread fraudulent urine testing that was not medically necessary between 2011 and 2015, according to an indictment. Once the prescriptions were filled, members of the conspiracy submitted fraudulent claims to federal, state and private insurers for the compounded drugs, prosecutors said. Among those charged were 76 doctors, 23 pharmacists, 19 nurses and other medical personnel, the announcement states.

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United States v. James Moorehead: James Moorehead, a registered nurse, was charged with three counts of acquiring a controlled substance by misrepresentation, fraud, deception, or subterfuge, and seven counts of false statements relating to health care matters. To maximize proceeds, Global engaged in additional fraudulent practices including automatically refilling and billing for prescriptions, regardless of patient need, and routinely waiving co-pays to incentivize patients to accept unnecessary medications and refills, according to charges and plea agreements in the case.

The takedown is considered to be one of the largest health care fraud busts in U.S history.

"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 Deputy Chief of IRS Criminal Investigation Eric Hylton.

The HHS also announced Thursday that between July 2017 and the present, it has excluded 2,700 health care providers from participation in any federal health care programs, such as Medicare, for alleged misconduct.

They are being charged for their roles in prescribing and distributing addictive painkillers.



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