This blog has covered Medicare/Medicaid fraud fairly regularly. And with the increasing costs of healthcare and the instability of the system, it seems likely that scams and schemes will become more and more profitable (and thus, more and more criminal).
One of the latest scams that has been uncovered has been called the “biggest national health care fraud takedown in history,” according to the local news station. Over 400 medical professionals across the country have been charged. The fradulent insurance claims, many of which related to opioid painkillers, cost taxpayers over a billion dollars. One of the medical professionals implicated in the scheme is podiatrist Perrin Edwards, who works in the Capital area of New York, around Albany. Edwards is accused of submitting false claims over the years, totaling upwards of $147,00.00. He faces up to ten years in prison, plus restitution.
The scheme is currently being charged by national prosecutors, with Attorney General Jeff Sessions announcing that the scam defrauded taxpayers of around $1.3 billion dollars. He has also recently announced a major law enforcement action in July which targets health-care fraud, particularly opioid treatments and pain management clinics which exploit Obamacare insurance plans. The Justice Department has begun to crack down on fraudulent claims to the biggest insurers. Many drug addiction treatment centers file bogus claims, as well as people who file reimbursement claims for drugs they begin to sell on the street, are set to be arrested and charged. One of the biggest expected areas to be affected is Southern Florida, where hundreds of residential drug addiction treatment centers are based. Of the over 400 defendants, at least 120 are suspected to have had a hand in illegal distribution of opiates, including a Houston, Texas clinic that allegedly gave out 12,000 prescriptions amounting to over 2 million doses – illegally.
At the same time, a report should be released by the Office of Inspector General for the Department of Health and Human Services, investigating waste, fraud, and abuse in government health programs, with a particular emphasis on estimated opioid use around the country. And while local doctors are targeted, major companies have also been hit by the new law enforcement programs. Mallinckrodt PLC, who makes pain medications, agreed to pay $35 million in a settlement concerning allegations that it failed to alert the Drug Enforcement Administration after receiving suspicious orders from pharmacies and pain clinics.
Targeting fraud against Medicare and Medicaid is nothing new; however, this plan is focusing on fraud against private insurers by the treatment programs that have taken advantage of Obamacare and its more generous coverage. Private insurers are largely on board, including Blue Cross and Blue Shield, saying it is actively working with both state and federal officials across the country on cases of this sort. However, it should be noted that federal prosecutors have already brought a few of these cases to trial, even if there is special interest in it now. In May, the owner of a sober house in Florida, Kenneth Chatman, received a 27-year sentence when he pled guilty to healthcare fraud, money laundering and human trafficking. He was convicted of using drug addicts as sex slaves while he received their insurance money which was intended to be used to pay for treatment programs.