DOJ charges 149 people for hundreds of millions of dollars of healthcare fraud, drug diversion

fraud
The Department of Justice has announced several fraud takedowns in recent weeks. (studiocasper/iStock)

The Department of Justice (DOJ) announced several healthcare fraud takedowns of late, resulting in dozens of charges, including many against medical professionals. 

Across the three fraud takedowns, 149 people were charged across fraud schemes totaling millions billed unlawfully to government and private payers.  

“Physicians and other medical professionals who fraudulently bill our federal healthcare programs are stealing from taxpayers and robbing vulnerable patients of necessary medical care,” said Brian Benczkowski, assistant attorney general in the DOJ’s criminal division. “The Department of Justice will continue to use every tool at our disposal, including data analytics and traditional law enforcement techniques, to investigate, prosecute and punish this reprehensible behavior and protect federal programs from abuse." 

Free Daily Newsletter

Like this story? Subscribe to FierceHealthcare!

The healthcare sector remains in flux as policy, regulation, technology and trends shape the market. FierceHealthcare subscribers rely on our suite of newsletters as their must-read source for the latest news, analysis and data impacting their world. Sign up today to get healthcare news and updates delivered to your inbox and read on the go.

RELATED: 14 doctors, medical professionals among those charged in $258M fraud cases in 3 states 

Here’s a look at the results of the three takedowns: 

Florida, Georgia takedown leads to charges against 67 people 

DOJ filed charges against 67 people in Georgia and Florida for fraud schemes totaling more than $160 million in unlawful bills to Medicare, Medicaid and private insurance. In a number of cases, those charged allegedly submitted bills for unnecessary care including home health, prescription drugs and durable medical equipment. 

Separately, 16 people were charged in Florida for Medicare fraud totaling more than $1.2 million, DOJ said. Of those, one was a licensed mental health professional, according to the announcement. 

In Georgia, charges in two cases targeted fraudulent prescription of opioids. Pharmacist David Williford, 69, of Rincon, Georgia, was charged with one count of obtaining a controlled substance (in this case oxycodone) by misrepresentation, fraud or forgery. 

RELATED: 16 doctors and medical professionals charged in fraud and opioid takedown in Texas 

In addition, Darien Pharmacy and pharmacist Janice Ann Coulter, 62, of Darien, Georgia, were named in a civil complaint that alleged the pharmacy and pharmacist dispensed controlled substances that were not issued for medical reasons, according to DOJ. 

“The drug dealer stereotype involves violent gang members peddling poison in our streets, but often the illicit dealers wear white coats and work in medical offices," said Bobby Christine, U.S. attorney of the Southern District of Georgia. 

“People who violate medical oaths and ethical codes to turn illegal profits by fueling the opioid crisis will find prosecutors and investigators working tirelessly to swap their lab coats for prison uniforms,” Christine said. 

Northeastern fraud takedown results in charges against 48, additional guilty pleas in telemedicine scheme 

A coordinated fraud takedown across seven districts in the Northeast led to charges against 48 people, including 15 doctors and medical professionals, related to $160 million in fraudulent claims, $800 million in total losses and 3.25 million opioid pills at “pill mills,” DOJ announced

As part of the takedown, DOJ charged 24 people for their roles in diverting opioids, according to the announcement. 

The Justice Department also announced as part of the takedown that three more people had pleaded guilty to a role in one of the largest fraud schemes ever pursued by the feds. Elliot Loewenstern, 56, of Boca Raton, Florida, a marketer for the Video Doctors Network, a telemedicine company involved in the fraudulent billing. 

RELATED: Telemedicine CEO pleads guilty to role in $424M fraud scheme 

Loewenstern pleaded guilty to his role in a scheme where telemedicine doctors were paid bribes to prescribe orthopedic braces that were not medically necessary in order to bilk federal payers, DOJ said.  

As part of his plea, Loewenstern agreed to pay $200 million in restitution to the U.S. 

33 charged as part of Gulf Coast takedown 

DOJ announced charges against 33 people in the Gulf Coast as part of two healthcare fraud actions in the region. 

Eleven people were charged for allegedly playing a role in Medicaid, Medicare and TRICARE fraud schemes totaling $515 million in fraudulent billing and efforts to obtain oxycodone and other controlled substances fraudulently, according to DOJ. 

In addition, 22 people, including 19 certified mental and home health professionals, were charged with defrauding Louisiana’s Medicaid program out of $300,000, DOJ said. 

“Healthcare fraud steals valuable resources from those truly in need and tarnishes the hard-earned respect of honest healthcare providers who deliver legitimate healthcare for their fellow Americans every day,” said Brandon Fremin, U.S. attorney of the Middle District of Louisiana.

Suggested Articles

Humana filed suit Friday against more than a dozen generic drugmakers alleging the companies engaged in price fixing.

Ochsner Health System is partnering with Color to launch a population health pilot program to integrate genetic information into preventive care.

Nominations are open for our 2020 FierceHealthcare Fierce 15 awards. Think your company has what it takes? Submit your nominations here.