June 2018 |
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Largest Fraud Enforcement Action in History

Attorney General Jeff Sessions and Department of Health and Human Services Secretary Alex M. Azar III announced today the largest health care fraud enforcement action in Department of Justice History. The takedown charged 601 individuals, across 58 federal districts for their alleged participation in health care fraud schemes involving more than $2 billion in false billings. Among the 601 charged for fraud, 162 defendants were additionally charged for their roles in prescribing opioids and other dangerous narcotics.

This enforcement action, while broad in geographic focus, was specific in its aggressive targeting of schemes billing government health care programs (Medicare, Medicaid, and TRICARE) and private insurance companies for medically unnecessary prescription drugs and compounded medications, as well as the unlawful distribution of opioids and other prescription narcotics.

According to court documents, the defendants allegedly participated in schemes to submit claims to Medicare, Medicaid, TRICARE, and private insurance companies for treatments that were medically unnecessary and often never provided. In numerous cases, patient recruiters, beneficiaries, and other co-conspirators were allegedly paid cash kickbacks in return for supplying beneficiary information to providers, so that the providers could then submit fraudulent bills to Medicare.

Of the 601 defendants charged for fraud,165 are medical professionals. Among the 162 defendants charged for their roles in distributing opioids, 76 are doctors. The number of medical professionals charged is especially significant because virtually every health care fraud scheme requires a corrupt medical professional to be involved in order for Medicare or Medicaid to pay the fraudulent claims.

Attorney General Sessions highlights hiring more prosecutors and leveraging the power of data analytics as key elements of achieving such a large-scale takedown. The FBI, DEA, Health Care Fraud task forces, HHS, Defense Criminal Investigative Service, IRS Criminal Investigation, Medicare, 30 state Medicaid Fraud Control Units, and over 1,000 federal, state, local, and tribal law enforcement officers across the country were all involved in today’s takedown.

The immense proportions of fraud, defendants, and medical professionals charged in today’s single operation are a testament to the rapidly advancing efficiency within the DOJ to find and prosecute medical fraud. Healthcare fraud enforcement is a priority for the federal government as it involves millions of citizens compiled in thousands of insurance pools, billions of dollars, and in some instances may involve conduct that potentially places patients in harm’s way. Recent Department of Justice initiatives to thwart healthcare fraud has brought on increased attention to medical practices, hospitals, labs, pharmacies, surgery centers, and MSO’s (management services organizations) among others. With this increased attention comes more audits and investigations.

Elliott Sauter, PLLC is a team of attorneys who not only have a record of handling healthcare criminal defense cases, but are in fact a firm founded by former federal prosecutors. We apply the knowledge and experience attained at the Department of Justice to assist clients that are being investigated or have been charged with a federal crime.


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