MASSIVE MEDICARE SCAM: US Announces Charges in $2.5 Billion Health Care Fraud Takedown

The U.S. Department of Justice made an announcement on Wednesday, revealing a law enforcement action against 78 defendants across 16 states. The charges, totaling $2.5 billion, are linked to alleged health care fraud schemes specifically targeting vulnerable groups such as the elderly, disabled individuals, HIV patients, and even pregnant women.

The range of cases includes accusations of fraudulent billing to the federal Medicare insurance program, involving illegal kickbacks and the diversion of costly prescription medications. Furthermore, improper dispensing of highly addictive opioid painkillers was also uncovered.

Among those indicted are 24 licensed medical professionals, including doctors and nurses, as well as health care executives, including current and former CEOs of an online platform for durable medical equipment, who are accused of submitting fraudulent claims amounting to $1.9 billion.

Out of the alleged fraudulent claims made to Medicare, state Medicaid programs, and private insurers’ supplemental Medicare programs, approximately $1.1 billion was paid out to the perpetrators, according to officials.

Attorney General Merrick Garland emphasized the determination of the Justice Department to identify and prosecute criminals who engage in defrauding Americans and exploiting taxpayer-funded programs.

The charges, unveiled between June 12 and Wednesday, involve a series of cases that share similar characteristics in terms of fraudulent schemes.

Some of the cases are connected to expensive HIV medications, which can lead to Medicare reimbursements of up to $10,000 for a month’s supply. In one instance, a pharmaceutical wholesale distribution company owner from New Jersey was charged with illicitly purchasing diverted HIV drugs and reselling them by falsely claiming they were obtained through legitimate channels.

Another case involved the indictment of a Wisconsin business owner who targeted low-income pregnant women, enticing them to sign up for prenatal care services and submitting fraudulent claims for services that were never provided.

Many instances of Medicare fraud typically exploit elderly or disabled patients who are deceived into providing their personal insurance information to telemarketers promising free testing, medical equipment, or other services covered by Medicare. In these schemes, doctors without any genuine relationship with the patients would falsely certify the medical necessity of the orders. The claims are then submitted to federal or state insurance programs for reimbursement, with each participant in the scheme often receiving illegal kickbacks or bribes.

These fraudulent schemes commonly target medical services with high reimbursement rates. In the past, durable medical equipment, genetic testing, and other laboratory diagnostic services have been the focus of such schemes.

{Matzav.com}