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Justice Department Charges 78 In Attempted $2.5B Health Care Fraud

Federal authorities have charged 78 defendants, including physicians and business executives, with more than $2.5 billion in attempted health care fraud, the Justice Department said Wednesday. Officials said the accused swindlers made off with $1.1 billion by filing untruthful claims to Medicare, state Medicaid programs, and supplemental Medicare insurance programs offered by private insurers, says the Wall Street Journal. The cases include alleged schemes targeting some of the most vulnerable patients, including the elderly, disabled, and those diagnosed with HIV. One of the cases involved current and former executives of purported software and services companies charged with conspiring to generate and sell false physicians’ orders for pain creams and orthotic braces in exchange for bribes and kickbacks. The companies operated an internet platform, DMERx, that created orders and prescriptions falsely saying that Medicare beneficiaries had been examined and treated by physicians, prosecutors said. In fact, purported telemedicine companies had paid physicians to sign the documents without regard to medical necessity. In some cases, the orders and prescriptions were based on only a brief telephone call with the Medicare beneficiary or sometimes with no interaction at all. In one case, the owner of a wholesale pharmaceutical distribution company was charged with illegally buying HIV medication, then reselling the drugs. Prosecutors said the distributor bought the drugs at a discount from people who obtained them through illegal “buyback” schemes, in which they paid HIV patients for their medication and repackaged the pills for resale. In some cases, prosecutors said defendants defrauded programs for the elderly and disabled to bankroll luxurious lifestyles marked by yachts and expensive cars. The Justice Department seized or froze millions of dollars worth of assets including automobiles, cash, and real estate as part of the enforcement action. Twenty-four physicians and other licensed medical professionals were charged with submitting more than $150 million in false billings. Among that group were doctors charged with providing patients with opioids they didn’t need. “When individuals divert addictive opioid medications for personal gain, they are knowingly putting Americans at risk, all too often causing harm and even death,” said Anne Milgram of the Drug Enforcement Administration. “DEA is committed to taking decisive action to hold accountable anyone who participates in these dangerous schemes.”

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