In a significant law enforcement action, the US Justice Department has announced federal and local criminal charges against 78 defendants across 16 states.
The charges are part of a massive healthcare fraud scheme, totaling $2.5 billion, that specifically targeted elderly and disabled individuals, HIV patients, and even pregnant women.
US Justice Department Charges 78 Defendants in $2.5 Billion Case
The alleged offenses cover a wide range of fraudulent activities, including falsely billing the federal Medicare insurance program for elderly and disabled Americans, engaging in illegal kickbacks, diverting expensive prescription medications, and dispensing highly addictive opioid painkillers improperly.
Among those facing charges are 24 doctors, nurses, and licensed medical professionals, as well as healthcare executives, including current and former CEOs of a durable medical equipment online platform.
These individuals are accused of falsely billing a staggering $1.9 billion in fraudulent claims.
Of the $2.5 billion in alleged fraudulent claims submitted to Medicare, state Medicaid programs, and supplemental Medicare insurance programs offered by private insurers, approximately $1.1 billion was actually paid out to the fraudsters, according to officials.
Attorney General Merrick Garland emphasized the commitment of the Justice Department to apprehend and bring justice to those who defraud Americans and exploit taxpayer-funded programs.
The charges, which were filed or unsealed between June 12 and the present, involve a series of cases characterized by similar types of fraudulent schemes.
Some cases involve the exploitation of expensive HIV medications, which can command Medicare reimbursement rates as high as $10,000 per month’s supply.
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Multi-State Healthcare Scam Targeting Elderly and Disabled Patients
For instance, one case in New Jersey saw the owner of a pharmaceutical wholesale distribution company charged with illegally purchasing diverted HIV drugs and subsequently reselling them by falsely claiming they were obtained through legitimate channels.
In another case, federal officials announced an indictment against a business owner in Wisconsin accused of targeting low-income pregnant women.
The defendant allegedly enticed them to sign up for prenatal care services and then submitted phony claims for services that were never provided.
A common tactic employed in many Medicare fraud schemes involves deceiving elderly or disabled patients into sharing their personal insurance information with telemarketers.
These fraudsters promise them free testing, medical equipment, or other services covered by Medicare.
Subsequently, doctors with no genuine relationship to the patients falsely certify the orders as medically necessary.
The fraudulent claims are then submitted to federal or state insurance programs for reimbursement, with each participant in the scheme often receiving illegal kickbacks or bribes as payment.
Fraudsters tend to focus on medical services with the highest reimbursement rates, including durable medical equipment, genetic testing, and other lab diagnostic services.
The Justice Department’s crackdown on this $2.5 billion healthcare fraud scheme signifies its dedication to combating fraud, protecting vulnerable populations, and preserving the integrity of taxpayer-funded programs.
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