Health Care

Largest Health Care Fraud Sweep

Largest Health Care Fraud Sweep”

The arrests came in dozens of unrelated prosecutions the Justice Department announced together as part of an annual healthcare fraud takedown.

The government also announced charges against 165 doctors, nurses and other medical professions, saying they had helped worsen the nation's opioid crisis by participating in the unlawful distribution of the painkillers.

While the Justice Department has been conducting investigations into some opioid manufacturers like OxyContin maker Purdue Pharma LP, the cases stemming from the sweep did not focus on wrongdoing by major corporations. In the District of Idaho, three defendants, all of whom are medical professionals, were charged for their roles in three separate fraud schemes involving controlled substances.

Many defendants are charged with schemes to bill the government health care programs Medicare, Medicaid and Tricare and other private insurers for unnecessary treatments and prescriptions. Kitco Metals Inc. and the author of this article do not accept culpability for losses and/ or damages arising from the use of this publication.

About 460,000 patients covered by Medicare received high amounts of opioids in 2017 and 71,000 were at risk of misuse or overdose, according to a report released on Thursday by the U.S. Department of Health and Human Services.

Dr. Kim allegedly took part in a scheme to submit claims to Medicare for physical therapy services that were not medically necessary, not provided, or otherwise did not qualify for reimbursement.

The case is considered the largest fraud in healthcare in USA history. Among those charged were 76 doctors, 23 pharmacists, 19 nurses and other medical personnel, the announcement states.

Officials said health care fraud is not only about the monetary damages, which saw some of those charged receiving hundreds of thousands of dollars of fraudulent proceeds, but the crackdown is also about public safety.

In numerous cases patient recruiters, beneficiaries and others involved in the schemes were paid cash kickbacks in return for supplying beneficiary information to providers, allowing the providers to submit fraudulent bills to Medicare, according to court documents. 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.

In yet another case, seven people were named in an indictment alleging multiple health care fraud conspiracies in which the owner of two pharmacies submitted claims to Medicare and Medi-Cal for expensive, brand-name prescription drugs that were never dispensed to patients.

"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.

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