Photographer: Kiyoshi Ota/Bloomberg

Trump’s First Health-Care Fraud Sweep Targets Doctors, Opioids

Updated on
  • Bogus billings cost taxpayers $1.3 billion, Sessions says
  • Care providers among more than 400 people charged nationwide

The U.S. accused more than 400 doctors, caregivers and others nationwide in health-care frauds it says bilked taxpayers of $1.3 billion, as the Trump administration laid down its intention to pursue excessive medical costs, opioid addiction and drug-related crimes.

Attorney General Jeff Sessions, in an enforcement announcement Thursday, rolled together dozens of long-running investigations by prosecutors across the U.S. that have brought arrests and charges from California to Florida. Prosecutors in those cases have accused health-care providers and others of making fraudulent claims to private insurers and the government.

Some are accused of billing Medicare, Medicaid and a veterans’ program for services that weren’t performed. Others were charged for prescribing opioids and other narcotics that weren’t necessary and in some cases ended up being sold on the street. In one case, a Florida drug-treatment program lured addicts with gift cards and trips to casinos and strip clubs so it could fraudulently bill insurance companies for their care, the U.S. said.

The prosecutions represent the biggest-ticket takedown of health-care fraud in U.S. history, Sessions said in a joint announcement with Health and Human Services Secretary Tom Price. They’re also the most sweeping enforcement to date by the Justice Department under President Donald Trump, as the administration positions itself against spiraling health-care costs and opioid addiction on a day when Congress sparred over the future of American health care and the government’s top health watchdog released new facts on opioid use and fraud in the U.S.

Sessions faulted the accused medical professionals of putting greed ahead of patients, turning practices into multimillion dollar criminal enterprises and ultimately sparking broader ills.

“Their actions not only enrich themselves often at the expense of taxpayers but also feed addictions and cause addictions to start. The consequences are real: emergency rooms, jail cells, futures lost, and graveyards,” Sessions said. “We will continue to find, arrest, prosecute, convict and incarcerate fraudsters and drug dealers wherever they are.”

Affront to Americans

Sessions’ presentation came as Senate Republicans released a revised bill to repeal and replace parts of the Affordable Care Act that allocates $45 billion for substance-abuse treatment and recovery. Some Republicans, in rejecting a previous version of the legislation, said they wanted more funding to help states combat the opioid addiction epidemic. It’s unclear whether the revised bill would win enough votes to pass.

Medical fraud is an affront to the Americans who rely on national health-care programs because it jeopardizes doctors’ ability to provide affordable care, Price said. “That is why this administration is committed to bringing these criminals to justice," he said, citing Trump’s request for $70 million to fund a health-care fraud and abuse control program.

The rollout continued a Justice Department tradition of announcing a major health-care enforcement action each summer. Federal prosecutors, some of whom have been working on these cases for a year or more, were directed to accelerate their efforts in time for Thursday’s announcement, one person familiar with the matter said. The Justice Department didn’t specify when the arrests occurred, but some took place over the past week, according to court filings. The government described several cases in its statement but didn’t name the defendants.

Strike Force

The actions included more than a half-dozen cases run by U.S. attorneys working in conjunction with the decade-old Medicare Strike Force, the Justice Department said, and dozens more conducted in U.S. attorney’s offices across the country. 

Of the 412 people charged, 56 were doctors and 120 cases were related to opioids. The government is moving to suspend or ban 295 providers, including doctors, nurses and pharmacists from participating in federal health programs, Sessions said.

Opioid abuse and deaths from overdoses are at epidemic levels in the U.S., according to a report released Thursday by the HHS’s Office of Inspector General, which investigates waste, fraud and abuse in government health programs, including Medicare and Medicaid. According to the latest data available from the National Institute on Drug abuse, more than 33,000 Americans died from opioid overdoses in 2015. More than a half-million Americans served by Medicare received what the government considers high amounts of opioid painkillers last year, according to the report.

Southern Florida has the biggest concentration of residential treatment centers in the country -- hundreds are based mainly in single-family homes in and around Delray Beach, a small town in Palm Beach County, north of Miami. A December 2016 grand jury report commissioned by the State Attorney for Palm Beach County found addiction treatment centers to be rife with operators who use deceptive marketing, illegal patient brokering and fraudulent insurance claims to profit from addicts.

Fraudulent claims became so rampant that Cigna Corp., the fourth-biggest U.S. health insurer, quit Florida’s Obamacare market in the fall of 2015, ahead of the sign-up period for 2016 plans. At the time, the company blamed fraudulent and abusive practices by drug-treatment centers for driving up its costs.

— With assistance by Michael Smith, Zachary Tracer, and Anna Edney

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