DOJ investigates $2.5 billion health care fraud scheme across nation

The Justice Department has recently announced a major crackdown on healthcare fraud, telemedicine scams, and illegal prescription schemes, totaling $2.5 billion in alleged fraud. This two-week national law enforcement effort has resulted in charges against 78 defendants, including 24 doctors, nurses, and other licensed medical professionals. The cases were brought in 16 states, including California, Florida, Georgia, and New York.

As part of the enforcement action, officials have issued 90 Medicare and Medicaid revocations and billing suspensions. Additionally, they have seized or restrained millions of dollars in cash, automobiles, and real estate. Attorney General Merrick Garland expressed the Department's commitment to combating fraud and prosecuting those who profit from it, stating, "The Justice Department will find and bring to justice criminals who seek to defraud Americans and steal from taxpayer-funded programs."

Many of the schemes targeted vulnerable populations, such as the elderly, individuals with mental health issues, pregnant people, those with opioid addictions, and those at risk of contracting HIV. In one case, leaders of a software company are alleged to have conspired to create a platform that allowed doctors and telemarketers to coordinate the sale of medical equipment in exchange for kickbacks. The defendants targeted disabled and elderly patients with letters, calls, and advertisements to sign up for unnecessary medical equipment or prescriptions. Fake Medicare order forms were generated to make it appear as though the equipment orders were legitimate.

Prosecutors claim that this conspiracy resulted in $1.9 billion in fraudulent reimbursement claims submitted to Medicare and other government insurers. In another case, a licensed physician in Washington state is accused of signing over 2,800 fraudulent orders for orthotic braces, including for patients who had already undergone amputations. Other cases involve individuals buying back HIV medications from patients and repackaging them to be sold to pharmacies, sometimes with incorrect labels or broken pills.

These enforcement actions reflect the Justice Department's intensified efforts to combat healthcare fraud and protect taxpayer-funded programs. By targeting individuals who seek to defraud Americans, the Department aims to bring justice to those who exploit vulnerable populations and steal from vital healthcare programs.


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