August 26, 2016 - Posts

DOJ’s Sweeping Healthcare Fraud Takedown Ensnares Small Players Who Wreak Big Damages

Most of the time, the schemes to defraud the United States that grab the biggest headlines are big, high-dollar schemes, perpetrated by large companies such as hospital chains, pharmaceutical companies, defense contractors, and the like. However, this June, the United States Justice Department made a strong statement that individuals and small companies are not exempt from scrutiny.


On Wednesday, June 23, 2016, Attorney General Loretta Lynch announced the “largest takedown ever” of companies and individuals accused of defrauding the United States. This takedown involves 301 different defendants—including more than 60 licensed medical professionals—who have been charged with a variety of fraudulent schemes, ranging from improper physical therapy and psychotherapy to fraudulent orders for durable medical equipment (DME), giving and receiving unlawful kickbacks in exchange for patient referrals, and fraudulent home health services.


Cumulatively, the Department of Justice estimates that these 301 defendants have been responsible for about $900 million in fraudulent payments by the government. This sweep follows a similar action from 2015 that resulted in criminal and/or civil actions against 243 different individuals and companies. These actions by the Justice Department are an important reminder that fraud against the government is a serious problem. CMS estimates that Medicare loses as much as $60 billion per year to fraud, waste and abuse.


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