Doctors, Nurses, Other Healthcare Pros Rounded up in Opioid and Medicare Fraud Sweep

Healthcare FraudDoctors, nurses, addiction treatment professionals, pharmacists and hundreds of others are among the 601 people across 58 federal districts charged this week in what the Justice Department is calling “the largest national healthcare fraud enforcement action” in its history. The fraud resulted in more than $2 billion in losses.

Of those 601, more than 162 were charged for their roles in prescribing and distributing opioids and other dangerous narcotics. Seventy-six were doctors.

The takedowns were, in part, the result of a promise made earlier this year by Attorney General Jeff Sessions to target drug manufacturers and distributors for their roles in the opioid epidemic. At that time, Sessions promised to use criminal and civil penalties to hold those accountable.

“Health care fraud costs taxpayers billions of dollars, increases medical costs and even helps fuel the national opioid crisis,” Florida Attorney General Pam Bondi stated in a news release.  “Our law enforcement partners and my Medicaid Fraud Control Unit aggressively investigate fraud in Florida, and as part of this massive nationwide effort, we were able to arrest some of the worst offenders and stop the illegal sale of prescription opioids—and hopefully safe (sic) lives.”

In Florida, 124 individuals were charged for their alleged participation in various fraud schemes involving more than $337 million in false billings for services including home healthcare, substance abuse treatment, lab testing and pharmacy fraud. They included physicians, sober house owners, addiction counselors, treatment center employees, pharmacists, pharmacy techs and pharmacy owners.

In one Florida case, the owner, medical director, and two employees of a sober living facility were charged in a scheme that illegally recruited patients, paid kickbacks, and defrauded health care benefit programs for widespread fraudulent urine testing.  During the course of the fraudulent scheme, the facility submitted more than $106 million in claims for substance abuse treatment services.

In another Florida case, a pharmacist and pharmacy technician who co-owned a Miami pharmacy were alleged to have billed for approximately $1.6 million in claims for prescription medications that were never purchased or provided to Medicare beneficiaries. The scheme was allegedly carried out by paying kickbacks to patient recruiters in exchange for Medicare beneficiaries’ information that was used to submit false and fraudulent claims.

You can find a list of those charged by clicking here.

Florida has one of the highest rates for opioid-involved doctor arrests in the country, according to a study published earlier this year by the website Detox. It found Florida had 4.3 arrests per 10,000 physicians and 23.7 overdose deaths per 100,000. West Virginia ranked No. 1, followed by Pennsylvania, Mississippi, Utah and Maine.

The report also found opioids to be the most common substance involved in physician arrests, with almost 1-in-3 related to overprescribing oxycodone and 1-in-4 related to overprescribing hydrocodone.

Although most healthcare professionals who prescribe opioids do so legitimately, it is imperative that they work to ensure they are doing so in a way that not only protects a patient from becoming addicted, but also protects their practice.

The Health Law Offices of Anthony C. Vitale focuses its practice on healthcare fraud defense. Mr. Vitale represents clients under investigation by the Department of Justice, FBI, Office of the Inspector General, DEA, Office of the Attorney General Statewide Prosecutor and Medicaid Fraud Control Unit, Florida Department of Insurance Division of Insurance Fraud and other investigatory bodies.

If you have any questions contact us at 305-358-4500 or send us an email to info@vitalehealthlaw.com.

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It is not intended as professional advice and should not be construed as such.