601 Criminal Healthcare Fraud Indictments Proves Enforcement Remains a Top Priority for Federal and State Authorities

The Department of Justice and the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG) just announced another historic “takedown” of criminal indictments and government actions to crack down on healthcare fraud. Consistent with takedowns from previous years, this year’s announcement touts jaw-dropping amounts of alleged fraudulent billings (over $2 billion) and indictments (over 600 individuals charged), which reinforces the government’s focus on enforcement of healthcare fraud laws. Texas remains a major focal point for these efforts.

Attorney General Sessions called it “the largest healthcare fraud enforcement action in American history. This is the most fraud, the most defendants, and the most doctors ever charged in a single operation. By every measure we are more effective at finding and prosecuting medical fraud than ever.” The takedown shows a coordinated effort between state and federal law enforcement, including the DOJ, HHS-OIG, FBI, DEA, IRS, CMS, the Department of Defense, and the Medicaid Fraud Control Units for many different states. It also underscores the DOJ vigilance in pursuing illegal opioid activity and the continued vitality of the DOJ’s Healthcare Fraud Strike Force.

Moreover, the takedown evidences an aggressive targeting of healthcare providers dealing with Medicare, Medicaid, and TRICARE (a health insurance program for members and veterans of the armed forces and their families). Importantly, private healthcare insurance companies are also heavily involved in these efforts. The takedown announced criminal charges against 601 charged defendants, of which 76 were doctors, 89 were nurses and other licensed medical professionals, and many other patient recruiters, beneficiaries, and others said to have facilitated the schemes. Law enforcement also announced that it had excluded 2,700 individuals from participation in Medicare, Medicaid, and all other federal healthcare programs.

Given the DOJ’s recent announcement of an unprecedented hiring of 311 more federal prosecutors, these enforcement efforts (and the resources to support them) will undoubtedly increase.

Given the complexities of the laws and the aggressiveness of the law enforcement efforts, we recommend that no healthcare provider engage with government authorities without experienced and skilled counsel.