Combating Health Care Fraud: 2024 National Enforcement Action

Health care fraud is a crime that impacts every American. It siphons off hard-earned tax dollars meant to provide care for the vulnerable and disabled. When health care providers and executives place greed above patients’ needs, it increases the cost of care for all Americans. Even worse, as the prosecutions announced on Thursday highlight, health care fraud can harm patients and fuel addiction.

Combating health care fraud is a critical priority for the Justice Department. That is why we established the Health Care Fraud Unit within the Criminal Division’s Fraud Section. Since the Unit’s inception in March 2007, prosecutors have been stationed across the country — from Brooklyn, New York, to Los Angeles — to provide a dedicated and forceful response to the problem.

Thursday’s announcement underscores how our approach has resulted in historic law enforcement success. Over just the past two weeks, the Health Care Fraud Unit has charged — either on its own or in partnership with U.S. Attorneys’ Offices — nearly 200 defendants with committing over $2.7 billion in health care fraud. Over a quarter of the defendants charged are medical professionals.

But this announcement is only the latest in a series of accomplishments. Since 2007, the Health Care Fraud Unit has charged more than 5,400 defendants with fraudulently billing Medicare, Medicaid, and private health insurers more than $27 billion. In recent years, the average loss associated with the schemes prosecuted by the Health Care Fraud Unit has steadily risen, underscoring our focus on the most egregious offenders.

How does the Health Care Fraud Unit accomplish these results year after year? Through a data-driven approach that responds to evolving threats and partnerships across the government.

First: data. The Health Care Fraud Unit has a dedicated data analytics team that monitors billing trends, identifies aberrant providers, and helps our prosecutors spot emerging schemes and stop them. These cutting-edge data analytics jumpstarted our investigations of Done ADHD and a separate $900 million amniotic wound care fraud scheme. Beyond those cases, proactive data analysis also led the Health Care Fraud Unit to investigate a spike in genetic testing claims at a laboratory in Houston. Our prosecutors pursued this lead, which ultimately resulted in an indictment against the owner of that laboratory in connection with a $356 million scheme to bill Medicare for medically unnecessary genetic tests that were induced by kickbacks.

These cases show how the department’s investment in data analytics produces outsized returns.

Second, the Unit responds to evolving threats. For many years, the Unit followed the data to launch Strike Forces in cities identified as health care fraud hot spots. But then the COVID-19 pandemic ushered in a new era of telemedicine, with schemes that spanned the entire country. We responded by creating the National Rapid Response Strike Force to address emerging, complex schemes.

This new Strike Force has been a success. It has helped lead our response to telemedicine and laboratory schemes, including by partnering with the Dallas Strike Force to charge another $54 million genetic testing scheme announced on Thursday. In addition to stealing taxpayer money, the defendants responsible for this scheme are alleged to have laundered their criminal proceeds through, among other things, the purchase of luxury cars.

Perhaps most importantly, through this model, we rapidly deploy prosecutors to stop schemes in their tracks.

For example, when law enforcement obtained evidence that Arizona’s Medicaid agency was being defrauded in connection with addiction treatment services allegedly provided to Native Americans, the Strike Force surged resources there. On Thursday, in partnership with the District of Arizona, we announced charges against three defendants, including the owner of an outpatient treatment center, for a $69 million health care fraud and money laundering scheme. This center claimed to provide addiction treatment services for people suffering from alcohol and drug addiction. But the indictment alleges that, in reality, the center either provided no services at all to patients or provided services that were so substandard that they failed to serve any valid treatment purpose. While legitimate outpatient treatment centers, or “sober” homes, can provide drug- and alcohol-free environments that are crucial to promoting and sustaining long-term recovery, the department will aggressively prosecute those who exploit vulnerable individuals for profit.

Third is our whole-of-government approach. One of the Health Care Fraud Unit’s key strengths, as demonstrated on Thursday, is our partnerships across government, including with law enforcement and other prosecutors. This enforcement action is the direct result of close coordination among the Health Care Fraud Unit, U.S. Attorneys’ Offices across the country, State Attorneys General, Medicaid Fraud Control Units, and our law enforcement agency partners. I would like to extend a special thanks to our partners, including the Department of Health and Human Services Office of the Inspector General, FBI, Drug Enforcement Administration, and Homeland Security Investigations. These partnerships are critical for our work to have maximum impact.

In closing, the cases we have announced show our unwavering commitment to rooting out fraud, wherever it may be found, and no matter who it implicates. And we are using more tools than ever before to uncover misconduct and hold wrongdoers to account — whether they are executives in corner offices or doctors who violate their oaths — including and especially when it comes to corporate healthcare fraud.

There’s more to come. This spring, we announced a pilot program to encourage individuals to come forward and report criminal schemes that we don’t otherwise know about. If you call us before we call you and assist us in investigating and prosecuting more culpable individuals, you may be able to earn a non-prosecution agreement.

Our message is clear: we are committed to protecting the American people and the critical health care programs that help them. And we will continue to hold accountable to the fullest extent of the law those who exploit these programs and place greed and profits above patient care.

Department of Justice
Office of the U.S. Attorney
Middle District of Alabama

Source: Justice.gov