Feds charge more than 400 in national fraud bust

Special report: Homegrown fraud task forces promote collaboration
Attorney General Jeff Sessions says federal agencies are continuing to find ways to uncover fraud faster. (Getty/Devonyu)

Federal agencies conducted an “unprecedented” nationwide healthcare fraud takedown, with 412 charged in crimes that accounted for $1.3 billion in false claims.

The Department of Justice and Department of Health and Human Services Office of Inspector General announced Thursday that the charges were filed in 41 federal districts as part of the bust and 115 medical professionals, namely doctors and nurses, were among those charged (PDF).

The action was the largest taken against health fraud in DOJ history, according to the department. The annual takedown is in its eighth year, and the number of people charged continues to grow. Last year, the agencies charged 301 people, and 243 people were charged in 2015.

Attorney General Jeff Sessions said the agencies are working to develop new techniques to identify more fraud cases faster.

“We are sending a clear message to criminals across the country: We will find you. We will bring you to justice,” Sessions said. “And, you will pay a very high price for what you have done.”

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The Trump administration signaled that would make fighting health fraud a priority through its budget proposals, which slashed funding to agencies like the National Institutes of Health but increased allocations to the Health Care Fraud and Abuse Control program.

Sessions highlighted some of the fraud cases involved and noted a significant number of cases were related to opioid claims. As part of the takedown, 295 people were served exclusion notices by OIG related to opioid abuse and diversion, preventing them from submitting claims to federal healthcare programs.

In one instance, a fake drug rehabilitation facility in Palm Beach, Florida, recruited addicts using gift cards, visits to strip clubs and drugs so it could filed claims for more than $5.8 million in false tests and treatments, Sessions said. In another case, staff at an illegal Houston clinic handed out opioids in exchange for cash.

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In tandem with the takedown announcement, OIG released a report (PDF) on inappropriate prescribing of opioids in Medicare Part D. A third of Medicare Part D beneficiaries were prescribed an opioid in 2016, and 500,000 beneficiaries were prescribed high amounts of opioid medications.

The report also found that 90,000 beneficiaries were considered high-risk for abuse, and about 22,000 showed signs of doctor shopping to acquire drugs. About 400 prescribers had inappropriate prescribing patterns for these high-risk beneficiaries, the report found.

“We must address prescribers with questionable prescribing patterns for opioids to ensure that Medicare Part D is not paying for unnecessary drugs that are being diverted for resale or recreational use,” the OIG concluded.