Over 100 US healthcare providers are charged in $1.3bn fraud case

BMJ 2017; 358 doi: (Published 17 July 2017) Cite this as: BMJ 2017;358:j3452
  1. Michael McCarthy
  1. Seattle

US law enforcement officials have charged 412 individuals in more than 30 states—including 115 doctors, nurses, and other medical professionals—for allegedly participating in healthcare fraud schemes involving over $1.3bn (£1bn; €1.13bn) in false billings.

In a 13 July press conference announcing the indictments Jeff Sessions, US attorney general, said that many of the cases involved prescription and distribution of opioids and other narcotics, contributing to the country’s ongoing opioid addiction epidemic.

“Too many trusted medical professionals like doctors, nurses, and pharmacists have chosen to violate their oaths and put greed ahead of their patients,” said Sessions. “Amazingly, some have made their practices into multimillion dollar criminal enterprises. They seem oblivious to the disastrous consequences of their greed.”

Among more than 50 000 US residents who die each year from a drug overdose, opioids were involved in 60% of cases, of which nearly half involved a prescription opioid, said the US Centers for Disease Control and Prevention, and methadone, oxycodone, and hydrocodone were the most common.

In one case, six doctors in Michigan were charged for allegedly submitting false claims to Medicare worth $164m, including bills for unnecessary opioid prescriptions, many of which ended up for sale on the street. In another case, a doctor operating from an illegal clinic in Houston, Texas, allegedly wrote more than 12 000 prescriptions for opioids amounting to two million doses.

In a sophisticated operation in southern Florida, the owner and operator of a fake drug treatment center and home for recovering addicts allegedly recruited addicted patients to move to the state so that the center owner and co-conspirators could charge their insurers for fraudulent testing and treatment.

To recruit patients, the co-conspirators allegedly offered kickbacks in the form of gift cards, free airline travel, trips to casinos and strip clubs, and drugs. The center filed $58m worth of fraudulent medical insurance claims for purported drug treatment services, said Sessions.

The investigation was led by the Medicare Strike Force, a multi-agency group created 10 years ago to target healthcare fraud. Since its formation the strike force has charged more than 3500 people for falsely billing Medicare for a total of more than $12.5bn. The new enforcement action, however, is the largest such action ever conducted in the US, officials said.

Sessions said that this latest enforcement action was “just the beginning” of legal actions taken to tackle healthcare fraud. “We are sending a clear message to criminals across the country: we will find you. We will bring you to justice. And you will pay a very high price for what you have done,” he warned.

In addition to false claims submitted to Medicare—the federal health plan for elderly people—the charges involved claims made to Medicaid, the health plan for low income and disabled people run by the federal government and the states; and TRICARE, the health insurance plan for members of the armed forces, veterans, and their families.

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