DOJ’s $2.7 Billion Health Care Fraud Crackdown: What We Know

The U.S. Justice Department said Thursday it filed criminal charges against 193 people, including 76 doctors and other medical professionals, across the country over health care schemes that could have caused $2.75 billion in losses.

The actual losses amounted to $1.6 billion, the government said in a statement. Authorities managed to seize more than $200 million cash, luxury cars, gold and other assets in the 2024 National Health Care Fraud Enforcement Action.

“It does not matter if you are a trafficker in a drug cartel or a corporate executive or medical professional employed by a health care company, if you profit from the unlawful distribution of controlled substances, you will be held accountable,” U.S. Attorney General Merrick Garland said in the statement. “The Justice Department will bring to justice criminals who defraud Americans, steal from taxpayer-funded programs, and put people in danger for the sake of profits.”

The cases include a $900 million scheme that involved amniotic wound grafts. The DOJ alleged that four suspects filed false claims to Medicare for the treatment that targeted terminally ill elderly patients.

“In just 16 months, Medicare paid two defendants more than $600 million as a result of their fraud scheme, paying on average more than a million dollars per patient for these unnecessary grafts,” the DOJ said.

Other charges involved a nurse practitioner in Florida who is accused of prescribing 1.5 million Adderall and other pills to patients across the country without engaging with the patients through a servicer’s auto-refill policy.

“This policy allowed patients to obtain continued prescriptions after an initial encounter without any further audio or visual interaction with a medical professional,” the government said. “This allegedly resulted in the nurse practitioner prescribing Adderall and other stimulants to individuals suffering from drug addiction and continuing to issue Adderall prescriptions for months after the overdose deaths of patients.”

Other scams involved a wire fraud conspiracy worth close to $90 million that involved selling misbranded HIV drugs, which led to some unsuspecting individuals being sold the wrong drugs.

“Patients received bottles labeled as their prescription medication, but the bottles contained a different drug entirely, with one patient passing out and remaining unconscious for 24 hours after taking an anti-psychotic drug thinking it was his prescribed HIV medication,” the DOJ said.

Another case involved false claims for addiction services worth $146 million, while another, worth $1.1 billion, accused 36 people of filing false Medicare claims through a telemedicine scheme.

“Those who steal from these programs are stealing from the American families who rely on them and putting patients at risk,” Department of Health and Human Services Deputy Secretary Andrea Palm said in the statement. “We won’t stop until all those who try to defraud the federal government are caught and held accountable.”