DOJ Announces $1.3 Billion Health Care Fraud Enforcement Action

The Department of Justice has announced that charges have been filed against 412 defendants, across 41 districts, to recoup approximately $1.3 billion in false billings to the Medicare, Medicaid and TRICARE programs. Defendants include doctors, nurses, pharmacists and other licensed medical professionals.

The allegations target healthcare fraud schemers who allegedly defrauded federal healthcare programs at the expense of taxpayers, including allegations of billing for medically unnecessary prescription drugs and compounded medications, as well as unlawful distribution of prescription opioids and narcotics.

There are also allegations of kickbacks between patient recruiters, beneficiaries, and other co-conspirators and providers. According to the DOJ’s announcement:

…co-conspirators were allegedly paid cash kickbacks in return for supplying beneficiary information to providers, so that the providers could then submit fraudulent bills to Medicare for services that were medically unnecessary or never performed.

The DOJ’s announcement does not directly discuss or indicate any allegations regarding the pharmaceutical industry’s potential role in providers’ prescribing habits.

However, It is interesting to note the results of both a 2013 study published by the Social Science Research Network, as well as a recent Drexel University Study.

The authors of the 2013 study used Pro Publica’s “Dollars for Docs” and “Prescriber Checkup” databases to conduct a cross-sectional regression analysis of physician prescribing habits. The authors of the study concluded that: “A payment from a pharmaceutical company corresponds to, on average, an additional 29 Medicare prescriptions per year.”

The recent Drexel University study published in the Journal of General Internal Medicine, conducted a cross-sectional survey of more than 3,500 adults across the nation, and referenced data from the “Open Payments” government database. Genevieve Pham-Kanter, PhD, an assistant professor in Drexel’s Dornsife School of Public Health said:

These findings tell us that if you thought that your doctor was not receiving any money from industry, you’re most likely mistaken. Patients should be aware of the incentives that their physicians face that may lead them to not always act in their patients’ best interest. And the more informed patients are about their providers and options for care, the better decisions they can make.

Nolan Auerbach & White is committed to working with whistleblowers to stop fraud affecting federal healthcare programs. Whistleblowers are insiders who are often the only people who both understand the fraud and have the evidence to help prove it. More information for potential whistleblowers is located on our main website.