The Department of Justice (DOJ) announced charges against 324 individuals the law enforcement agency said were behind more than $14.6 billion of healthcare fraud.
The charges were spearheaded by the Health Care Fraud Unit of the DOJ Criminal Division’s Fraud Section and more than double law enforcement’s prior $6 billion record for a coordinated healthcare fraud takedown, according to a Monday release.
Included in the effort were more than $245 million seized by the government during enforcement along with civil settlements with 106 defendants totaling $34.3 million.
“This record-setting Health Care Fraud Takedown delivers justice to criminal actors who prey upon our most vulnerable citizens and steal from hardworking American taxpayers,” Attorney General Pamela Bondi said a release. “Make no mistake—this administration will not tolerate criminals who line their pockets with taxpayer dollars while endangering the health and safety of our communities.”
Further, the Centers for Medicare & Medicaid Services (CMS) said the enforcement effort prevented the payout of more than $4 billion of false and fraudulent claims, with 205 associated providers having their billing privileges pulled in recent months.
The Department of Health and Human Services Office of Inspector General (HHS-OIG), as well as the Drug Enforcement Administration, the FBI and other federal and state law enforcement, collaborated with the DOJ’s Health Care Fraud Unit.
“The scale of today’s Takedown is unprecedented, and so is the harm we’re confronting. Individuals who attempt to steal from the federal health care system and put vulnerable patients at risk will be held accountable,” acting Inspector General Juliet T. Hodgkins of the HHS-OIG said in a release. “Our agents at HHS-OIG work relentlessly to detect, investigate, and dismantle these fraud schemes. We are proud to stand with our law enforcement partners in protecting taxpayer dollars and safeguarding patient care.”
Much of the announcement highlighted charges against 29 individuals alleged to be participating in transnational criminal organizations, who law enforcement said submitted more than $12 billion in fraudulent claims.
Chief among these was an investigation dubbed “Operation Gold Rush,” which tallied the DOJ’s largest loss amount ever charged. It involved “a network of foreign straw owners, including individuals sent into the United States from abroad, who, acting at the direction of others using encrypted messaging and assumed identities from overseas, strategically bought dozens of medical supply companies located across the United States,” the DOJ said.
Those individuals allegedly submitted more than $10 billion in fraudulent claims to Medicare. Of the 12 who have been arrested, four were apprehended in Estonia in cooperation with Estonian law enforcement and seven were arrested at U.S. airports or at the U.S.-Mexico border when trying to escape the country, according to the release.
Operation Gold Rush did result in about $900 million of payments from Medicare supplemental insurers and $41 million of Medicare payments, though the HHS did cut off $4.4 billion of scheduled Medicare payments that are being returned to the Medicare trust fund.
The DOJ’s release also highlighted charges against seven defendants connected to $1.1 billion of fraudulent claims for amniotic wound allografts, 74 defendants tied to alleged diversion of over 15 million prescription opioid and controlled substance pills, and 49 defendants said to be connected to almost $1.2 billion of false claims from telemedicine and genetic testing fraud schemes.
"Every dollar we prevent from going to fraudsters is a dollar that stays in the system to serve legitimate beneficiaries,” CMS Administrator Mehmet Oz, M.D., said in the announcement. “Through advanced data analytics, real-time monitoring, and swift administrative action, CMS is leading the fight to protect Medicare, Medicaid, and the trust Americans place in these vital programs.”
The DOJ’s Health Care Fraud Strike Force was formed in 2007 and, prior to Monday’s announcement, had collectively charged more than 5,400 defendants who’d collectively billed plans more than $27 billion. The unit created a Data Analytics Team in 2018 to better target complex schemes.
In Monday’s announcement, the DOJ said that team would be coordinating with others in the Criminal Division, HHS-OIG, the FBI and more agencies to create a Health Care Fraud Data Fusion Center that will “leverage cloud computing, artificial intelligence and advanced analytics to identify emerging healthcare fraud schemes.” The effort falls in line with an executive order from March aiming to increase operational efficiency by breaking down data silos and reducing duplicative data teams, the DOJ said.