Last week, the Department of Health and Human Services Office of Inspector General performed the single largest healthcare fraud takedown in U.S. history. Aided by local and federal law enforcement, the Medical Fraud Strike Force arrested over 400 individuals on various accounts of fraud and and conspiracy to commit fraud. Of those charged, 115 were licensed professionals such as doctors and nurses.
The bust, which involved over 1,000 law enforcement agents including 350 Medical Fraud Strike Force operatives, took place in 41 federal districts ranging from California to Puerto Rico. Those charged were found to have falsified medical claims in order to procure more money for their practices. In total, the defendants enacted schemes that stole over $1.3 billion worth of federal money.
Among the various fraudulent claims were allegations of physician kickbacks, or physicians providing payment or reward in order to encourage new referrals. In one of the largest individual takedowns that made up the larger bust, nine Michigan defendants were charged with stealing $218 million via kickbacks, tests that were never performed, and controlled drugs that were then sold for personal profit.
The Michigan providers were not the only ones found guilty of over-prescribing opioid painkillers to patients who did not demonstrate adequate need or who had a history of drug abuse. In one Houston clinic, the physicians in charge prescribed hydrocodone to as many as 60 to 70 people per day and simply charged $300 cash per patient without any regard for medical necessity. In California, two physicians were arrested for filing claims for painkillers that were never even given to the patients in the first place.
Though this was the largest medical fraud takedown to date, the Medical Fraud Strike Force is far from done. The taskforce reports that they have recovered five dollars for every one spent on their operations, meaning that there is plenty more incentive to continue to crack down on fraud all across the country.