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DOJ and OIG Announce Largest Ever National Health Care Fraud Takedown; Focus on Opioids

Continuing its annual tradition, the U.S. Department of Justice (“DOJ”) and the U.S. Department of Health and Human Services (“HHS”) announced last week the largest ever health care fraud enforcement action by the Medicare Fraud Strike Force.  As part of the national health care fraud takedown, the government charged 412 defendants with approximately $1.3 billion in alleged fraud. In addition to these charges, HHS Office of Inspector General (“OIG”) is in the process of excluding 295 health care providers from participating in federal health care programs.

With the goal of sending a loud and strong message of deterrence to medical professionals, the government focused this year’s takedown on medically unnecessary prescriptions and services billed to Medicare, Medicaid, or TRICARE that were often never actually provided. The government also targeted the illegal distribution of prescription narcotics by health care providers that is contributing to the wide-reaching opioid epidemic. In one emblematic case, DOJ charged a health care provider in Texas with prescribing medical unnecessary narcotics that led to deaths from drug overdoses.

The national health care fraud takedown is conducted by the Medicare Fraud Strike Force, along with its partners in state and federal agencies. The Medicare Fraud Strike is part of a joint initiative between DOJ and HHS to deter health care fraud and to enforce current laws.  The takedown was led by DOJ’s Criminal Division, U.S. Attorney’s Offices, and the Federal Bureau of Investigation, as well as OIG. State Medicaid Fraud Control Units, the Drug Enforcement Agency, and the Defense Criminal Investigative Service assisted.  The Medicare Fraud Strike Force has charged over 3,500 defendants with alleged participation in fraudulent health care schemes amounting to over $12.5 billion since it began in March 2007.

DOJ’s press release regarding the takedown can be found here.  OIG also issued a fact sheet that can be found here.

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About this Author

Eoin P. Beirne, Mintz, White Collar Crime Investigations Attorney, FCPA Violations Lawyer,

Eóin is an accomplished white collar defense lawyer who resourcefully shepherds individual and corporate clients through government investigations and enforcement proceedings. He represents clients in a wide variety of industries in state and federal courts and before an array of investigative and enforcement bodies. Eóin routinely represents Boards of Directors or Board committees conducting internal investigations. He counsels clients on a variety of matters including wire and mail fraud, health care fraud, public corruption, insider trading, and violations of the False Claims Act and...

Sarah Beth S. Kuyers, Mintz Levin, nonprofit affiliation lawyer, health care systems attorney

Sarah Beth’s practice involves a variety of regulatory, transactional, and enforcement defense matters for clinical laboratories, hospitals, pharmacies, insurers, and other health care clients.

Sarah Beth routinely advises clients on a wide variety of federal and state health care regulatory issues, including anti-kickback and self-referral laws, licensure and scope of practice rules, telemedicine, certificate of need applications, food and drug law, and HIPAA compliance. She also handles licensure and regulatory filings for clinical laboratories and other health care providers.

On the transactional side, Sarah Beth provides regulatory counsel for mergers and acquisitions involving pharmacies, pharmacy benefit managers, and other health care providers. She has assisted clients with due diligence, licensing, change of ownership, and contract drafting and negotiation.

Sarah Beth’s enforcement defense experience includes representing health care clients in criminal and administrative actions brought by federal and state agencies for potential violations of the federal anti-kickback statute, the Stark Law, and the False Claims Act. She has also has experience in internal investigations and compliance programs.

Sarah Beth actively participates in Mintz’s pro bono program. Currently, Sarah Beth represents children seeking Special Immigrant Juvenile (SIJ) Status from the U.S. Citizenship and Immigration Services. The SIJ program is available for foreign children who have been abused, abandoned, and neglected and have come to the United States.