On June 28th, the Department of Justice announced the conclusion of a two-week nationwide law enforcement operation aimed at addressing health care fraud and opioid abuse. During this operation, charges were filed against 78 defendants, alleging their involvement in schemes totaling over $2.5 billion in potential fraud. These individuals are accused of defrauding programs dedicated to the care of the elderly and disabled, and in some instances, using the illicit proceeds to acquire luxury items. 

Among the charges brought forth were cases related to telemedicine fraud, where 11 defendants were accused of submitting fraudulent claims exceeding $2 billion. The defendants are accused of conspiring to generate and sell templated doctors’ orders for orthotic braces and pain creams, allegedly resulting in $1.9 billion in false and fraudulent claims to Medicare and other government insurers. The defendants purportedly operated a software platform that facilitated the submission of deceptive orders, concealing the fact that patient interactions occurred remotely via telemedicine. The alleged scheme involved the manipulation of certifications and diagnostic testing required for Medicare reimbursement.

The enforcement action also encompassed charges related to pharmaceutical fraud, involving 10 defendants and the submission of over $370 million in potentially fraudulent claims. In one case, charges were filed against the owner and corporate officer of a pharmaceutical wholesale distribution company, accused of participating in a $150 million fraud scheme. The company allegedly purchased illegally diverted prescription HIV medication and misrepresented its acquisition as legitimate. The alleged scheme involved the falsification of labeling and product tracing documentation to mask the illegitimate nature of the drugs. As a result, pharmacies unknowingly dispensed misbranded medications, enabling the defendants to accrue substantial illegal profits.

The charges also targeted fraudulent billings related to opioid distribution and other forms of health care fraud, totaling over $150 million. Among the defendants were 24 physicians and medical professionals alleged to have illegally provided patients with unnecessary opioids. Additionally, charges included instances where healthcare companies, physicians, and providers purportedly offered cash kickbacks to patient recruiters and beneficiaries in exchange for patient information. Such actions would constitute fraudulent billing for Medicare reimbursement.

Assistant Attorney General Kenneth A. Polite, Jr. proclaimed “[t]oday’s announcement includes some of the largest and most complex cases that the Department has prosecuted and demonstrates the Department’s commitment to seeking justice for those at all levels of the healthcare industry who put profits above patient care, from professionals in doctors’ offices to executives in corporate boardrooms.” 

A complaint, information, or indictment is merely an allegation. All defendants are presumed innocent until proven guilty beyond a reasonable doubt in a court of law. The attorneys at Chilivis Grubman represent clients of all types and sizes in connection with health care fraud investigations.  If you need assistance with such a matter, please contact us today.