September 22, 2019

September 20, 2019

Subscribe to Latest Legal News and Analysis

September 19, 2019

Subscribe to Latest Legal News and Analysis

601 Charged in Record-Breaking Annual Health Care Fraud and Opioid “Takedown”

On June 28, the Department of Justice (DOJ) announced another record-breaking annual nationwide health care fraud “takedown.” The action, led by the Criminal Fraud Section of the Department of Justice, includes charges against 601 individuals, including charges against 156 doctors, nurses and other licensed medical professionals. Of those, the DOJ elaborated that 162 defendants, including 76 doctors, were charged for their roles in prescribing and distributing opioids and other dangerous narcotics. According to the DOJ, these schemes resulted in over $2 billion in fraudulent billings, and involved over 13 million illegal doses of opioids.

The 601 individuals charged in this year’s sweep represent a 45 percent increase from the 412 individuals who were charged in last year’s sweep. Similarly, the alleged $2 billion in loss reflects a more than 50 percent increase from the $1.3 billion that the DOJ claimed last year.

As in years past, the charges involve alleged schemes to defraud the Medicare, Medicaid and TRICARE programs, through home health care, pharmacy fraud, substance abuse testing and treatment, physical and occupational therapy, medical transportation, durable medical equipment and other areas of the health care industry. Notably, however, the DOJ emphasized what it described as a “particular focus on medical professionals involved in the unlawful distribution of opioids and other prescription narcotics.”

The DOJ further claimed that, in the past year, the Department of Health and Human Services (HHS) has excluded 2,700 individuals from participating in federal health care programs. In its own announcement, HHS claimed that, since the last takedown, it has issued exclusion notices to 587 individuals, including 67 doctors, 402 nurses, and 40 people involved in pharmacy services “whose conduct has contributed to opioid diversion and abuse.” These actions represent a significant investment of time, energy and resources by HHS in regulatory enforcement proceedings against medical professionals, in addition to the criminal enforcement efforts highlighted by the DOJ.

This announcement appears to reflect both an ongoing commitment by the DOJ to prosecute health care fraud and opioid abuse cases, and that the emphasis by HHS on administratively excluding providers has become a part of the enforcement landscape over the past year. We expect to see these efforts continue.

©2019 Drinker Biddle & Reath LLP. All Rights Reserved

TRENDING LEGAL ANALYSIS


About this Author

Antonio Pozos, Litigation lawyer, Drinker Biddle
Partner

Antonio M. Pozos represents clients in criminal litigation, internal investigations, government investigations, and related civil proceedings, with a particular emphasis on the health care industry, foreign corruption, public corruption, and cross-border disputes. He is an experienced trial lawyer and former federal prosecutor.

Tony has extensive criminal and civil experience in both federal and state courts. Before joining Drinker Biddle, Tony was a federal prosecutor with the Criminal Fraud Section of the U.S. Department of Justice, where he...

(215) 988-3327
Jesse Witten, Drinker Biddle Law Firm, Washington DC, Healthcare and Litigation Attorney
Partner

Jesse A. Witten defends health care providers, pharmaceutical manufactures and other clients in the health industry against fraud and abuse matters in government investigations and litigation, particularly False Claims Act matters. Jesse also assists clients in internal corporate investigations and self-disclosures to the government of regulatory violations and Medicare/Medicaid overpayment. He counsels clients on compliance with Anti-Kickback Statute and Stark Law and laws governing the sale and marketing of medical devices and pharmaceutical products.

Before joining Drinker Biddle, Jesse served as a Deputy Associate Attorney General in the U.S. Department of Justice, where he co-chaired the DOJ's health care fraud task force. He also served as a Deputy Assistant Attorney General in the DOJ Environment and Natural Resources Division. Jesse was previously a partner with an international law firm.

(202) 230-5146
Barry Gross, Corporate Investments Attorney, Drinker Biddle
Partner

Barry Gross, a former federal prosecutor, is a partner in the firm’s White Collar Crime and Corporate Investigation Practice Group. He is regularly engaged to represent individuals and companies in high-stakes criminal and civil matters. He represents companies, professionals and business executives in investigations and trials. His practice includes the defense of white collar criminal investigations and prosecutions, internal corporate investigations, as well as complex civil litigation including civil Racketeer Influenced and Corrupt Organizations (...

215-988-2872