October 20, 2019

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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 focuses on advising health care providers, PBMs, and laboratories on a variety of regulatory issues.

Prior to joining Mintz Levin, Sarah Beth worked as a law clerk with the health staff of the US Senate Committee on Finance, where she researched policy, regulations, and legislation regarding commercial insurance reform, health IT, Medicare, Medicaid, and the Affordable Care Act. She also drafted legislation.

In addition, Sarah Beth worked as a law clerk for a legal practice in Washington, DC. Her experience also includes legal internships with a large, nonprofit health care system and with the International Trade Administration of the US Department of Commerce.