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DOJ, HHS announce massive health care fraud crackdown

Given all of the recent discussion over the last week about the latest version of the healthcare bill, it's possible that many people overlooked a joint announcement by Attorney General Jeff Sessions and Department of Health and Human Services Secretary Tom Price concerning a national health care fraud crackdown.

While you might imagine this was just some run-of-the-mill press conference to inflate the results of relatively minor operation against a few providers, this was far from the case. Indeed, AG Sessions classified it as the largest health care fraud operation in the nation's history.

Last Thursday, the two high-ranking officials announced that charges were filed against an astounding 412 medical providers, including physicians, nurses and other licensed professionals, across 41 federal districts over their purported involvement in various conspiracies resulting in the creation of $1.3 billion in false billings.

The charges essentially outline how the accused parties submitted claims to Medicaid, Medicare and/or TRICARE (i.e., military insurance) for medically unnecessary services or prescriptions that were often never supplied. A multitude of the cases also allege that some providers paid cash kickbacks to patient recruiters, beneficiaries and co-conspirators for supplying the information needed to submit false claims.

The enforcement initiative was undertaken by the Medicare Fraud Strike Force, a join initiative between the HHS and the Department of Justice designed to deter and punish health care fraud.

“Healthcare fraud is not only a criminal act that costs billions of taxpayer dollars - it is an affront to all Americans who rely on our national healthcare programs for access to critical healthcare services and a violation of trust,” said Price.   

The operation was also classified as being the single largest opioid-related fraud crackdown in the nation's history with 120 defendants charged for their role in the unlawful prescription and distribution of dangerous narcotics.

It's worth noting that the operation resulted in charges being brought against several providers here in the Chicagoland area.

Based on the sheer size and scope of this operation, it would seem as if the DOJ will be making healthcare fraud a priority in the years ahead. As such, those who find themselves under investigation or facing these federal charges must seriously consider speaking with a skilled legal professional as soon as possible. 

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Darryl A. Goldberg
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