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."
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.
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.
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.