The figure that matters: $2 billion in allegedly fraudulent healthcare claims, and 15 people charged. The Justice Department announced the cases on Thursday. Six of the defendants are medical professionals. Eight were arrested in Los Angeles on Oct. 22 and seven others are charged and not yet in custody.
The bottom line is that these are several separate schemes, not one conspiracy. Prosecutors said the total is approximate, and some officials and news reports used $1.8 billion instead. The amounts are alleged claims or losses, not a finding of what any defendant took in.
By the numbers
One case makes up most of the total. Prosecutors say more than $1.6 billion was billed to private insurers for sham substance abuse treatment, which they called “the largest case of its type ever prosecuted by the Department.” Another $134 million was billed to Medicare for unnecessary atherectomy procedures that left patients injured, and more than $138 million to Medicare in three hospice schemes involving patients who were not terminally ill. The sweep also covers illegal kickbacks for genetic testing and patient referrals, the sale of prescription drug samples, and a previously charged Medi-Cal pharmacy case of nearly $270 million in claims for medically unnecessary prescriptions.
Inside the treatment scheme
Prosecutors say a father and son, David and Nathan Young, controlled dozens of treatment companies. Recruiters allegedly drew vulnerable people from across the country to facilities in Southern California and elsewhere with flights, housing, money and drugs, then billed insurers for care that was unnecessary or never given. Patients were allegedly shuffled between facilities to keep claims flowing, and some who tried to leave were drugged or blocked from going. A fifth defendant in that case, Nicholas Moore, has pleaded guilty and admitted helping submit about $199 million in claims.
The agencies and the stakes
The FBI, the Health and Human Services inspector general, IRS Criminal Investigation and the DEA worked the cases. The Health Care Fraud Strike Force has charged more than 6,200 defendants since 2007 in cases involving over $45 billion in billed claims.
First Assistant U.S. Attorney Bill Essayli said this is “the worst type of fraud” because doctors who swore to do no harm are putting their own financial interests ahead of patients. IRS Special Agent in Charge Darren Lian said healthcare fraud “is not a victimless crime” and drives up costs. All charges are allegations, and every defendant is presumed innocent until proven guilty in court.
Sources
- 15 people federally charged in connection with $2 billion fraudulent healthcare schemes, DOJ says
- Feds charge 15 in California health care fraud cases, $2 billion in claims
- Stock Portfolio Management & Tracker – Yahoo Finance
Photo: Marincyclist (CC BY-SA 4.0)
