Health care fraud is a crime that impacts every American. It siphons off hard-earned tax dollars meant to provide care for the vulnerable and disabled. When health care providers and executives place greed above patients’ needs, it increases the cost of care for all Americans. Even worse, as the prosecutions announced on Thursday highlight, health care fraud can harm patients and fuel addiction.
Combating health care fraud is a critical priority for the Justice Department. That is why we established the Health Care Fraud Unit within the Criminal Division’s Fraud Section. Since the Unit’s inception in March 2007, prosecutors have been stationed across the country — from Brooklyn, New York, to Los Angeles — to provide a dedicated and forceful response to the problem.
Thursday’s announcement underscores how our approach has resulted in historic law enforcement success. Over just the past two weeks, the Health Care Fraud Unit has charged — either on its own or in partnership with U.S. Attorneys’ Offices — nearly 200 defendants with committing over $2.7 billion in health care fraud. Over a quarter of the defendants charged are medical professionals.
But this announcement is only the latest in a series of accomplishments. Since 2007, the Health Care Fraud Unit has charged more than 5,400 defendants with fraudulently billing Medicare, Medicaid, and private health insurers more than $27 billion. In recent years, the average loss associated with schemes prosecuted by the Health Care Fraud Unit has steadily risen, underscoring our focus on the most egregious offenders.
How does the Health Care Fraud Unit accomplish these results year after year? Through a data-driven approach that responds to evolving threats and partnerships across government.
First: data. The Health Care Fraud Unit has a dedicated data analytics team that monitors billing trends, identifies aberrant providers, and helps our prosecutors spot emerging schemes and stop them. These cutting-edge data analytics jumpstarted our investigations of Done ADHD and a separate $900 million amniotic wound care fraud scheme. Beyond those cases, proactive data analysis also led the Health Care Fraud Unit to investigate a spike in genetic testing claims at a laboratory in Houston. Our prosecutors pursued this lead, which ultimately resulted in an indictment against the owner of that laboratory in connection with a $356 million scheme to bill Medicare for medically unnecessary genetic tests that were induced by kickbacks.
These cases show how the department’s investment in data analytics produces outsized returns.
Second: responding to evolving threats. For many years, the Unit followed data to launch Strike Forces in cities identified as health care fraud hot spots. But then COVID-19 ushered in a new era of telemedicine with schemes spanning across countries; we responded by creating National Rapid Response Strike Force to address emerging complex schemes.
This new Strike Force has been successful; it helped lead our response towards telemedicine & laboratory schemes including partnering Dallas Strike Force charging another $54 million genetic testing scheme announced Thursday where defendants allegedly laundered criminal proceeds through luxury car purchases among other things.
Perhaps most importantly through this model rapidly deploy prosecutors stopping schemes tracks e.g., when law enforcement obtained evidence Arizona Medicaid agency defrauded connection addiction treatment services allegedly provided Native Americans Strike Force surged resources there announcing charges three defendants including outpatient treatment center owner $69 million healthcare fraud money laundering scheme Thursday District Arizona partnership claiming provide addiction treatment services people suffering alcohol drug addiction indictment alleges reality center either provided no services all patients substandard failed serve valid treatment purpose while legitimate outpatient treatment centers sober homes provide drug alcohol-free environments crucial promoting sustaining long-term recovery department aggressively prosecute exploit vulnerable individuals profit
Third whole-of-government approach one key strengths demonstrated Thursday partnerships across government including law enforcement other prosecutors enforcement action direct result close coordination among Healthcare Fraud Unit US Attorneys Offices across country State Attorneys General Medicaid Control Units law enforcement agency partners extend special thanks partners including Department Health Human Services Office Inspector General FBI Drug Enforcement Administration Homeland Security Investigations partnerships critical work maximum impact
In closing cases announced show unwavering commitment rooting out fraud wherever found matter implicates using more tools ever uncover misconduct hold wrongdoers account whether executives corner offices doctors violate oaths especially corporate healthcare fraud
There’s more come spring announced pilot program encourage individuals come forward report criminal schemes don’t otherwise know about call us before call assist investigating prosecuting culpable individuals may able earn non-prosecution agreement message clear committed protecting American people critical healthcare programs help continue hold accountable fullest extent law exploit programs place greed profits above patient care