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Is the DOJ cracking down on specific types of healthcare fraud?

On Behalf of | Aug 2, 2023 | Health Care Investigations |

The United States Department of Justice (DOJ) recently announced criminal charges against 78 healthcare professionals. Attorney General Merrick Garland noted in the press release about the matter that the feds are intensifying their efforts to prosecute healthcare fraud.

What were the charges?

The DOJ along with various state and federal agencies worked to together to investigate healthcare professionals accused of filing false and fraudulent claims with Medicare and other government payers. Those under investigation included physicians and other medical professionals as well as pharmaceutical business owners and entrepreneurs connected to software companies.

The feds claim the crimes connected to this announcement cost the nation over $2.5 billion.

What did these healthcare professionals do wrong?

The bust brought down dozens of healthcare professionals, focused on three main categories:

  1. Telehealth. This category comprised most of the fraudulent efforts, generally targeting senior citizens and the disabled and upselling unnecessary medical devices and prescriptions like orthotic braces and skin creams.
  2. Pharmaceutical. The primary example here was a pharmaceutical wholesale distribution company that allegedly relabeled and resold HIV medication.
  3. Opioid prescriptions. The feds state the operation included 24 physicians and other medical professionals who illegally provided patients with medically unnecessary opioids and filed for fraudulent Medicare reimbursement.

The government has already seized over $10 million in assets connected to these allegedly fraudulent actions and will continue to pursue additional compensation in an attempt to recoup these funds. The prosecution will likely also push for additional financial penalties and may even consider imprisonment of those involved in these crimes.

What can those in similar situations learn from this announcement?

As noted above, the criminal penalties associated with these types of allegations are serious. It is important to note that for medical professionals the criminal side is only one repercussion to navigate. Doctors, nurses, and other medical professionals who face these allegations and hold a professional license will likely also face additional repercussions from the state licensing authority. This could mean the suspension or even revocation of their professional license.

Attorney John Rivas is responsible for this communication.

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