The Department of Justice recently announced a range of charges against almost 200 individuals accused of participating in health care fraud schemes with false claims of more than $2.75 billion in intended fraud loss. More than 190 defendants – including 76 doctors, nurse practitioners, and other licensed medical professionals – were charged over a span of two weeks and more than $231 million in cash, luxury vehicles, and other assets were seized in connection with the charges. In total, there are 110 federal cases in 32 districts (including Florida, North Carolina, and Tennessee) as well as 35 state cases in 11 states (including New York, Pennsylvania, and California)
Included in the charges are five defendants associated with a digital technology company who engaged in the unlawful distribution of millions of pills of Adderall and other stimulants; a fraud scheme of more than $900 million committed in connection with amniotic wound grafts; a fraud scheme of more than $90 million performed by corporate executives distributing adulterated and misbranded HIV medication; more than $1.1 billion in telemedicine and laboratory fraud; and more than $450 million in other health care fraud and opioid schemes.
The wide-ranging enforcement action required assets from various agencies of the government – including the Health Care Fraud Unit of the Criminal Division’s Fraud Section at the DOJ; various United States Attorneys’ offices; the Department of Health and Human Services Office of Inspector General (HHS OIG); the Federal Bureau of Investigation (FBI); and the Drug Enforcement Agency (DEA).
Amniotic Wound Grafts
In the District of Arizona, charges were filed against four individuals who allegedly filed $900 million in false and fraudulent claims to Medicare for amniotic wound grafts used on Medicare patients. The DOJ alleged that the four individuals targeted elderly Medicare patients who were often terminally ill and caused medically unnecessary (and expensive) amniotic grafts to be applied to the patients’ wounds, without coordination with the patients’ treating physicians and without proper treatment for infection, to superficial wounds that did not need the treatment, and in sizes that far exceeded the size of the wound.
In connection with these charges, the government seized more than $70 million, including four luxury vehicles, gold, jewelry, and cash.
Adderall Distribution
In another example of charges filed, five defendants associated with Done Global Inc. and its affiliated entity, Done Health P.C., were charged with unlawful distribution of millions of Adderall pills. The charges include those against a Florida nurse practitioner who prescribed more than 1.5 million pills of Adderall and other stimulants to patients across the United States, allegedly without interaction with patients under the “auto refill” policy at Done. The DOJ notes that the “auto refill” policy allowed patients to obtain prescriptions after an initial visit without any further audio or visual interaction with a medical professional. The DOJ further notes that the nurse practitioner mentioned here continued to prescribe Adderall and other stimulants to individuals who suffered from drug addiction or who had passed away due to an overdose.
These charges follow charges filed against the CEO and Clinical President of Done for involvement in a scheme to distribute Adderall and other stimulants over the internet.
Telemedicine and Laboratory Fraud, Illegal Prescription and Distribution of Opioids
Included in the charges are charges for 36 defendants in connection with the submission of more than $1.1 billion in fraudulent claims to Medicare as a result of telemedicine schemes.
Additionally, 14 defendants were charged with crimes related to the illegal prescription and distribution of opioids that resulted in millions in false billings. Under that umbrella are several charges against medical professionals who prescribed unnecessary opioids, Suboxone, and other controlled substances.
Reactions
“It does not matter if you are a trafficker in a drug cartel or a corporate executive or medical professional employed by a health care company, if you profit from the unlawful distribution of controlled substances, you will be held accountable,” Attorney General Merrick Garland said.
“Healthcare fraud victimizes patients, endangers the health of vulnerable people, and plunders healthcare programs,” said FBI Director Christopher Wray. “This wide-ranging collaboration demonstrates the FBI’s commitment to rooting out predatory healthcare fraud, protecting patients, and ensuring critical healthcare funds go where they are needed most.”