More Than 400 Charged in National Health Care Fraud

BREAKING: DOJ reports 'largest healthcare fraud takedown in history'

U.S. authorities slapped 412 doctors, nurses and other medical professionals with fraud charges, many for overprescribing opioids that have stoked an expanding national addiction crisis.

Harris added that the "epidemic must be attacked on multiple fronts" through a variety of means including stopping criminal doctors and medical professionals from writing "medically unnecessary" prescriptions. "The historic results of this year's national takedown represent significant progress toward protecting the integrity and sustainability of Medicare and Medicaid, which we will continue to build upon in the years to come".

Half of those charged in Arkansas were members of Houston street gangs who were burglarizing pharmacies from Texas to Virginia, according to a news release from Patrick C. Harris, acting US attorney for the Eastern District of Arkansas. The feds alleged this purported pain management clinic was the highest prescribing hydrocodone facility in Houston where clinicians saw roughly 60-70 people daily and the doctor prescribed "medically unnecessary" hydrocodone in exchange for approximately $300 cash per visit.

Ten individuals in NY charged with allegedly participating in a variety of schemes including kickbacks, services not rendered, and money laundering involving over $151 million in fraudulent billings to Medicare and Medicaid. The criminal complaint alleges that the mother was paid kickbacks for being part of the scheme. Those charged include 56 medical doctors, six of them part of a MI scheme that allegedly prescribed unnecessary opioids to patients and sent $164m in false and fraudulent claims to Medicaid. He said these individuals allegedly billed Medicare for $164 million in false claims. In the state's U.S. Attorney's Office of Southern District, 26 people face charges of defrauding the government out of $66 million. In addition, reducing further fraud stems the financial burden on the government and the country's taxpayers. The barely controlled pumping of hundreds of millions of doses of opioids into United States communities during the past decade is blamed for a sharp surge in addiction, with an estimated two million to three million people hooked on prescription painkillers or heroin, according to the American Society of Addiction Medicine.

Nonetheless, the trend of bigger takedowns indicates at least two issues, he says.

Fricke says other healthcare entities and healthcare professionals can learn lessons from the recent takedown.

Healthcare entities can also play a role in efforts to fight fraud, he notes. "Investing in user behavior analytics can help identify anomalous activities potentially leading to the discovery of fraud taking place".



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