The Justice Department has announced the 2024 National Health Care Fraud Enforcement Action, leading to criminal charges against 193 defendants. This includes 76 doctors, nurse practitioners, and other licensed medical professionals across 32 federal districts in the U.S. These defendants are accused of participating in various health care fraud schemes involving approximately $2.75 billion in intended losses and $1.6 billion in actual losses.
In collaboration with federal and state law enforcement partners, the government seized over $231 million in cash, luxury vehicles, gold, and other assets.
Attorney General Merrick B. Garland emphasized that the Justice Department would hold accountable anyone profiting from the unlawful distribution of controlled substances. Secretary of Homeland Security Alejandro N. Mayorkas and FBI Director Christopher Wray underscored the commitment to protecting patients and taxpayers from health care fraud.
The charges include schemes involving over $900 million in fraud connected to amniotic wound grafts, unlawful distribution of millions of Adderall pills by five defendants associated with a digital technology company, and a $90 million fraud by corporate executives distributing adulterated and misbranded HIV medication. Other schemes included over $146 million in fraudulent addiction treatment, $1.1 billion in telemedicine and laboratory fraud, and over $450 million in other health care fraud and opioid schemes.
The enforcement action was led by the Health Care Fraud Unit of the Criminal Division’s Fraud Section and included contributions from the U.S. Attorneys’ Offices, the Department of Health and Human Services Office of Inspector General (HHS-OIG), FBI, and Drug Enforcement Administration (DEA).
In connection with the amniotic wound grafts fraud, charges were filed in the District of Arizona against four individuals for filing $900 million in false claims to Medicare. The defendants allegedly targeted elderly Medicare patients, causing unnecessary and expensive treatments. The government seized over $70 million, including luxury vehicles, gold, jewelry, and cash.
Five defendants associated with Done Global Inc. were charged for unlawfully distributing millions of Adderall pills. The CEO and Clinical President of Done were charged in a scheme to distribute Adderall and other stimulants over the internet, allegedly without proper patient interaction.
Three owners and executives of a wholesale distributor were charged with introducing adulterated and misbranded HIV drugs into the market, involving a $90 million wire fraud conspiracy. The drugs were allegedly acquired through unlawful “buyback” schemes and resold to pharmacies with falsified documentation.
In the addiction treatment fraud cases, charges were filed against four defendants in Arizona and Florida for allegedly submitting over $146 million in false claims. These cases included fraudulently billing Medicaid for services not provided or provided at substandard levels.
Thirty-six defendants were charged in connection with $1.1 billion in fraudulent claims to Medicare through telemedicine schemes. These included illegal kickbacks and bribes for unnecessary genetic testing and minimal patient interactions.
Fourteen defendants were charged with crimes related to the illegal prescription and distribution of opioids, resulting in millions in false billings. An additional 126 defendants were charged with various other health care fraud schemes involving over $450 million in false claims.
The Center for Program Integrity of the Centers for Medicare and Medicaid Services (CMS) announced adverse administrative actions against 127 medical providers involved in health care fraud.
This enforcement action was supported by multiple federal and state agencies, including the FBI, HHS-OIG, DEA, CMS, Homeland Security Investigations (HSI), and others.
The Health Care Fraud Strike Force, operating in 27 districts since its inception in 2007, has charged over 5,400 defendants who collectively billed Medicare, Medicaid, and private health insurers more than $27 billion.
This article is based on a press release from the Office of Public Affairs of the Justice Department. For more information, click here.