DOJ Executes Largest Healthcare Fraud Enforcement in History

August 17th, 2017

In July, the Department of Justice (DOJ) and the Department of Health and Human Services (HHS) announced that they had charged more than 400 defendants from across the country in the largest healthcare fraud scheme ever uncovered by the agencies. This scheme involved approximately $1.3 billion and included 120 defendants who were charged with prescribing and distributing opioids and other narcotics. In all, HHS is seeking to suspend the licenses of 295 providers, including doctors, nurses, and pharmacists.

The agencies targeted medical professionals that were unlawfully involved in schemes to prescribe medically unnecessary prescription drugs and compounded medications. In many cases, the medications were never purchased and used by the beneficiary, but rather the medications were unlawfully distributed. Allegedly, medical professionals were paid kickbacks in return for supplying beneficiary information to providers who would submit fraudulent bills to Medicare, Medicaid, and Tricare for services that were never provided.

On August 2, Attorney General Jeff Sessions announced a new DOJ unit tasked with detecting opioid fraud and abuse. This is a pilot program aimed at combatting the opioid crisis in the United States. The program will consist of a central unit within the DOJ as well as funding for 12 assistant U.S. attorneys for a three-year term. These attorneys will investigate fraud and abuse related to opioid prescriptions, including so-called “pill mills.”