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DOJ charges 200 people for $2.7B healthcare scheme fraud

The Department of Justice (DoJ) recently announced the 2024 National Health Care Fraud Enforcement Action, including criminal charges against 193 defendants for their alleged participation in billions of dollars in fraud schemes.

Defendants, including 76 doctors, nurse practitioners and other licensed medical professionals, were charged in 32 federal districts across the US in 2024 for suspected involvement in various healthcare fraud schemes involving about $2.75 billion in intended losses and $1.6 billion in actual losses.

Federal and state law enforcement officials also seized over $231 million in cash, luxury vehicles, gold and other assets in connection with the healthcare fraud schemes identified by enforcement partners so far this year.

DoJ highlighted some of the schemes, including over $900 million in fraud cases committed in connection with amniotic wound grafts the unlawful distribution of millions of pills of Adderall and other stimulants by five defendants associated with a digital technology company; an over $90 million fraud committed by corporate executives distributing adulterated and misbranded HIV medication; over $146 million in fraudulent addiction treatment schemes; over $1.1 billion in telemedicine and laboratory fraud; and over $450 million in other healthcare fraud and opioid schemes.

“Health care fraud affects every American,” Principal Deputy Assistant Attorney General Nicole M. Argentieri, head of the Justice Department’s Criminal Division, said in the announcement. “It siphons off hard-earned tax dollars meant to provide care for the vulnerable and disabled. In doing so, it also raises the cost of care for all patients. Even worse, as the prosecutions we announce today underscore, health care fraud can harm patients and fuel addiction.”

The enforcement actions announced by the DoJ were led and coordinated by Argentieri’s division, as well as the Health Care Fraud Unit of the Criminal Division’s Fraud Section, US Attorneys’ Offices, the Department of Health and Human Services Office of Inspector General (HHS-OIG), FBI and and Drug Enforcement Administration (DEA). The cases are also being prosecuted by Health Care Fraud Strike Force teams from the Criminal Division’s Fraud Section, 32 US Attorneys’ Offices nationwide and 11 State Attorney Generals’ Offices.

“This work is important to the Department of Health and Human Services (HHS) and the millions of Americans we serve. HHS vigorously pursues anyone who commits fraud against our health care programs. But it takes all of us, working together, to be successful,” said HHS Deputy Secretary Andrea Palm. “Those who steal from these programs are stealing from the American families who rely on them and putting patients at risk. We won’t stop until all those who try to defraud the federal government are caught and held accountable.”

In addition to the DoJ’s enforcement action, CMS Administrator Chiquita Brooks-LaSure also said that her agency took 127 administrative actions over the past six months against providers for their alleged involvement in healthcare fraud schemes, many of which impacted Medicare. RevCycleIntelligence

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