Largest Health Care Fraud Sweep

01 July, 2018, 00:32 | Author: Joy Garcia
  • U.S. Attorney General Jeff Sessions arrives for a news conference to announce a nation-wide health care fraud and opioid enforcement action at the Justice Department in Washington

"Health care fraud schemes cost Americans billions of dollars every year through higher premiums and tax money stolen from public programs, such as Medicare", First Assistant U.S. Attorney Tracy L. Wilkison said.

In the Southern District of Florida, 124 people were charged with offenses relating to their participation in various fraud schemes involving more than $337 million in false billings for services including home health care and pharmacy fraud.

The United States Justice Department charged more than 600 people in what they are calling the largest health care fraud takedown in history.

The alleged scheme - spearheaded by Michael Drobot, the previously convicted former owner of Pacific Hospital in Long Beach - involved more than $40 million in illegal kickbacks paid to doctors and other medical professionals in exchange for referring thousands of patients who received surgeries and other services at Pacific Hospital.

The massive enforcement initiative - which spanned 58 federal districts - swept up 165 doctors, nurses and other licensed health professionals, including 76 doctors accused of prescribing and distributing opioids and other prescription painkillers.

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The charges in part involve billing government programs Medicare and Medicaid along with private insurers for medically unneeded prescription drugs, resulting in losses of more than $2 billion, according to the Justice Department and the Department of Health and Human Services. These are despicable crimes. Some cases are reported to be related to the nation's opioid epidemic. That's why this Department of Justice has taken historic new steps to go after fraudsters, including hiring more prosecutors and leveraging the power of data analytics. Federal officials said they also involved patient recruiters, beneficiaries and other co-conspirators paying kickbacks in return for providing beneficiary information to providers so providers could submit false Medicare claims.

The HHS also announced Thursday that between July 2017 and the present, it has excluded 2,700 health care providers from participation in any federal health care programs, such as Medicare, for alleged misconduct. The charges also involved unnecessary prescription drugs and compounded medications. Separately, dozens of distributors and drug manufacturers are facing charges from cities, states, counties, and Native American tribes in a consolidated case in an OH federal court that could yield an unprecedented settlement.

Dr. Yong Jun Kim, a medical doctor who operated My Health Wellness Center in Flushing, Queens, was charged with one count of conspiracy to commit health care fraud and one count of violating the anti kickback statute.

Peresiper, a medical clinic business manager, was charged with conspiracy to pay health care kickbacks related to Pulmonary Solutions and Multi Care Medical NY, both in Brooklyn.

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