February 23, 2020

February 21, 2020

Subscribe to Latest Legal News and Analysis

February 20, 2020

Subscribe to Latest Legal News and Analysis

Attorney General Announces Ninth Annual Fraud Takedown Targeting Opioid Epidemic

On June 28, 2018, Attorney General Jeff Sessions and Department of Health and Human Services (HHS) Secretary Alex M. Azar III announced the ninth year of the national health care fraud takedown. The takedown resulted in the largest government action against health care fraud, which involved more than 600 defendants from over 50 federal districts. The targeted fraud schemes accounted for more than $2 billion in false billings. The government specifically targeted billings for prescription drugs that were medically unnecessary and charges for medicines that were never purchased.

Similar to the 2017 crackdown on opioid treatment centers alleged to have submitted false or fraudulent claim to insurers, this year investigators focused on medical professionals who illegally distributed opioids to patients. The 2018 government takedown follows a CDC report which found approximately 115 people die from opioid-related overdoses each day. According to Attorney General Sessions, “This is the most fraud, the most defendants, and the most doctors ever charged in a single operation—and we have evidence that our ongoing work has stopped or prevented billions of dollars’ worth of fraud.”

The 2018 health care fraud takedown had operations in 58 federal districts, including districts in Ohio, Kentucky, Pennsylvania, Michigan, Illinois and California. The joint task force charged three defendants located within the Southern District of Ohio for their roles in two separate health care fraud schemes. All three of the defendants were medical professionals, and one allegedly received kickbacks related to illegal drug distribution.

In Kentucky, 12 defendants were charged. Five of the defendants were medical professionals, and the charges consisted of fraud, identity theft and money laundering.

The Pennsylvania action led to charges against 16 individuals for drug diversion schemes.

In the Northern District of Illinois, the Department of Justice charged 21 defendants for health care fraud totaling more than $54 million in fraudulent billing.

Finally, in California, the task force charged 44 individuals for their alleged roles in fraud and kickback schemes. These schemes involved $660 million in fraudulent billing.

The Medicare Fraud Strike Force was established in 2007. It has grown to 10 locations and has charged more than 3,700 individuals for falsely billing more than $14 billion to Medicare. Although the takedown focuses on criminal charges, it also encompasses civil enforcement of health care fraud schemes.

The Department of Justice press release can be found here

© 2020 Dinsmore & Shohl LLP. All rights reserved.


About this Author

Matthew Arend Litigation Attorney Dinsmore Shohl, privacy, data security

Matt is a member of the Health Care Practice Group, focusing his practice on all aspects of federal and state privacy and data security issues, including HIPAA compliance, breach analyses, and governance. He also routinely advises clients on compliance with federal and state anti-kickback laws, Stark law, Sunshine Act, Medicare Secondary Payer laws, pharmaceutical marketing rules and other regulatory matters. Additionally, his thorough knowledge of the healthcare arena enables him to counsel clients through audits and investigations, as well as providing training and...

Jennifer Mitchell, health care practice group partner, Dinsmore Shohl, law firm,

Jennifer is a Partner in the Health Care Practice Group and leads the firm’s HIPAA Privacy and Security practice and initiatives. In her HIPAA practice, she works with clients to minimize the risk of privacy and data security issues, assisting with all aspects of HIPAA privacy and security compliance, governance, audits/investigations, breach analyses, training and strategic planning. She has a thorough understanding of federal and state privacy and confidentiality laws and has served as a health care privacy expert witness. 

Within the constantly evolving health care legal landscape, in addition to HIPAA, Jen provides health care regulatory and compliance guidance to her clients in areas such as the federal and state anti-kickback laws, Stark law, PPACA (health reform), Sunshine Act, Medicare Secondary Payer laws, pharmaceutical marketing rules, ADA standards, and other laws and regulations impacting her health care clients.