The US Department of Justice (“DOJ”) has recently announced several healthcare fraud enforcement actions, charging 149 people for fraud schemes resulting in hundreds of millions of dollars in unlawful billings to the federal government healthcare programs.
These charges resulted from actions in the following three locations:
Florida and Georgia: The DOJ brought charges against 67 people for schemes resulting in more than $160 million in fraudulent bills to Medicare, Medicaid and third-party insurers. Many of the cases involved charges alleging the submission of bills for unnecessary care, such as home health, prescription drugs and durable medical equipment. An additional 16 people in Florida, including one mental health professional, were charged with defrauding Medicaid out of more than $1.2 million. In Georgia, two cases, including one against a pharmacist, were related to the fraudulent prescription of opioids.
Northeast: The DOJ brought charges against 48 people for schemes resulting in $160 million in fraudulent claims, $800 million in total losses and the distribution of 3.25 million opioid pills through “pill mills.” Of the 48 people charged, 15 were doctors or other healthcare professionals. Opioid diversion accounted for charges against 24 people. Of note in this area, the DOJ announced that Elliot Loewenstern, the Vice President of Marketing for the Video Doctors Network, pleaded guilty to one count of conspiracy to defraud the US for his participation in a fraudulent telemedicine scheme. In that scheme, telemedicine doctors were paid illegal kickbacks to prescribe medically unnecessary orthopedic braces, resulting in a loss of $424 million to Medicare and other insurance carriers. Loewenstern agreed to pay $200 million in restitution to the US as part of his plea agreement.
Gulf Coast: The DOJ brought charges against 33 people as part of two actions. In the first action, 11 people were charged for allegedly submitting $515 million in fraudulent bills to Medicare, Medicaid and TRICARE in an effort to obtain oxycodone and other controlled substances. In the second action, 22 people, were charged with defrauding Louisiana’s Medicaid program of $300,000. Of the 22 people charged, 19 were certified mental and home health professionals.
Focusing on the healthcare practitioners charged in the various cases, U.S. Attorney Brandon Fremin of the Middle District of Louisiana noted that “[h]ealth care fraud steals valuable resources from those truly in need and tarnishes the hard-earned respect of honest health care providers who deliver legitimate health care …. It is especially egregious when carried out by health care professionals who are betraying the trust given them by the community.” Assistant Special Agent in Charge Wayne Jacobs of the FBI’s Newark Field Office echoed the sentiment, adding “The FBI does not care about your status in life, your professional standing, your level of income, or your personal connections when you break the law.”